Struelens Marc J, Costers Michiel
Department of Microbiology, Université Libre de Bruxelles-Hopital Erasme, Brussels, Belgium.
Wien Klin Wochenschr. 2008;120(9-10):284-8. doi: 10.1007/s00508-008-0969-6.
While debate about optimal organization for hospital antibiotic stewardship programs is ongoing, limited information is available about the implementation of such programs in acute-care institutions. The ABS International project conducted a survey on the implementation and characteristics of hospital antibiotic management programs in several European countries. This paper summarizes the results for Belgium, where a federal program for developing multidisciplinary antibiotic management teams was started in 2002.
The survey was conducted in April and May 2007. A questionnaire with 39 items to be scored from 0 (absent) to 5 (fully available) was sent to medical directors and chairs of drugs and therapeutics committees in all acute-care hospitals to measure five dimensions of hospital antibiotic management. The results were analyzed by calculating the mean scores for the various items and topics.
Of 120 questionnaires sent, 46 (38%) were completed and returned in time for analysis. The three regions of the country were well represented by the respondents. The mean country maturity score of 3.75 (range 2.15-4.90) indicated that a well developed antibiotic management system was in place in most hospitals. Over 90% of hospitals had key structural resources and tools available for effective stewardship programs. Performance items that scored high were those related to microbiological diagnostics and surveillance of bacterial resistance (4.41), surveillance of antibiotic consumption (4.16) and organization of antibiotic guidance and support by trained antibiotic management officers (3.81). Items that scored lower were professional development of personnel (3.43) and co-ordination with outside healthcare providers (2.95). Hospitals with several years of funding for their antibiotic officer showed higher scores for antibiotic management but not for diagnostics.
Antibiotic stewardship programs are well developed in Belgian hospitals, particularly in those which first qualified for federal support. Extension of funding and technical assistance should help all hospitals to catch up with excellence standards, provided that adequate support is given to laboratory services and advanced training of professional specialists.
尽管关于医院抗生素管理项目的最佳组织形式的争论仍在继续，但关于此类项目在急性医疗机构中的实施情况的信息有限。ABS国际项目对几个欧洲国家医院抗生素管理项目的实施情况和特点进行了调查。本文总结了比利时的调查结果，该国于2002年启动了一项建立多学科抗生素管理团队的联邦项目。
调查于2007年4月和5月进行。一份包含39个项目的问卷被发送给所有急性医疗机构的医疗主任和药物与治疗委员会主席，这些项目的评分从0（不存在）到5（完全具备），以衡量医院抗生素管理的五个维度。通过计算各个项目和主题的平均得分来分析结果。
在发放的120份问卷中，46份（38%）及时完成并返回用于分析。受访者很好地代表了该国的三个地区。该国的平均成熟度得分为3.75（范围为2.15 - 4.90），这表明大多数医院都有完善的抗生素管理系统。超过90%的医院拥有有效管理项目所需的关键结构资源和工具。得分较高的绩效项目是与微生物诊断和细菌耐药性监测相关的项目（4.41）、抗生素消费监测（4.16）以及由受过培训的抗生素管理人员组织抗生素指导和支持（3.81）。得分较低的项目是人员的专业发展（3.43）和与外部医疗服务提供者的协调（2.95）。为抗生素管理人员提供多年资金支持的医院在抗生素管理方面得分较高，但在诊断方面得分并非如此。
比利时医院的抗生素管理项目发展良好，特别是那些首先获得联邦支持的医院。资金和技术援助的扩展应有助于所有医院达到卓越标准，前提是为实验室服务和专业专家的高级培训提供充分支持。
