Univ. de Bordeaux, U657, F-33000 Bordeaux, France.
J Antimicrob Chemother. 2011 Jul;66(7):1631-7. doi: 10.1093/jac/dkr179. Epub 2011 May 17.
French hospitals are urged by health authorities to develop antibiotic stewardship (ABS) programmes in order to improve antibiotic use and to decrease their consumption. We performed a longitudinal survey to describe ABS measures implementation and antibiotic use and to study relationships between ABS measures and trends in antibiotic use between 2005 and 2009.
Data on ABS, antibiotic use and activity were retrospectively collected by questionnaires sent to hospitals voluntarily participating in the south-western France network. ABS measures covered organization, resources, restrictive and persuasive actions. Antibiotic use was retrieved from pharmacy records and expressed as the number of defined daily doses/1000 patient-days according to national and WHO guidelines using 2009 defined daily dose values to monitor trends. Relationships between ABS measures and antibiotic use were studied by multivariate logistic regression.
Between 2005 and 2009, the degree of implementation of ABS increased in the 74 participating hospitals. Antibiotic use remained stable, with variations according to hospital groups and antibiotic classes. In hospitals with more ABS measures, antibiotic use in general and fluoroquinolone use tended to remain stable or to decrease. Educational activities were associated with a decrease in fluoroquinolone use in the univariate analysis. In the multivariate analysis, practice audits and time dedicated by the antibiotic advisor were significantly associated with a decrease in total antibiotic use and fluoroquinolone use, respectively.
This first longitudinal study, in 74 hospitals, showed that human resources and persuasive ABS measures, in the context of a multidisciplinary approach, are helpful in controlling total antibiotic and fluoroquinolone use.
法国卫生当局敦促医院制定抗生素管理（ABS）计划，以改善抗生素的使用并减少其消耗。我们进行了一项纵向调查，以描述 ABS 措施的实施情况和抗生素的使用情况，并研究 ABS 措施与 2005 年至 2009 年抗生素使用趋势之间的关系。
通过向自愿参与法国西南部网络的医院发送问卷，回顾性收集 ABS、抗生素使用和活动数据。ABS 措施涵盖组织、资源、限制和说服性措施。抗生素使用从药房记录中检索，并根据国家和世界卫生组织（WHO）指南，使用 2009 年的定义日剂量值来监测趋势，以每千名患者天的定义日剂量表示。通过多变量逻辑回归研究 ABS 措施与抗生素使用之间的关系。
在 2005 年至 2009 年期间，74 家参与医院的 ABS 实施程度有所提高。抗生素使用保持稳定，根据医院组和抗生素类别有所变化。在具有更多 ABS 措施的医院中，抗生素的一般使用和氟喹诺酮类药物的使用趋于稳定或减少。在单变量分析中，教育活动与氟喹诺酮类药物的使用减少有关。在多变量分析中，实践审计和抗生素顾问投入的时间与总抗生素使用和氟喹诺酮类药物使用的减少分别显著相关。
这项在 74 家医院进行的首次纵向研究表明，在多学科方法的背景下，人力资源和说服性的 ABS 措施有助于控制总抗生素和氟喹诺酮类药物的使用。
