Department of Pharmacy, Singapore General Hospital, Singapore, Singapore.
PLoS One. 2011;6(12):e28751. doi: 10.1371/journal.pone.0028751. Epub 2011 Dec 9.
Inappropriate prescription of antibiotics may contribute towards higher levels antimicrobial resistance. A key intervention for improving appropriate antibiotic prescription is surveillance of prescription. This paper presents the results of a longitudinal surveillance of broad-spectrum antibiotic prescription in 5 public-sector hospitals in Singapore from 2006 to 2010.
METHODOLOGY/PRINCIPAL FINDINGS: Quarterly antibiotic prescription data were obtained and converted to defined daily doses (DDDs) per 1,000 inpatient-days. The presence of significant trends in antibiotic prescription over time for both individual and combined hospitals was tested by regression analysis and corrected for autocorrelation between time-points. Excluding fluoroquinolones, there was a significant increase in prescription of all monitored antibiotics from an average of 233.12 defined daily doses (DDD)/1,000 inpatient-days in 2006 to 254.38 DDD/1,000 inpatient-days in 2010 (Coefficient = 1.13, 95%CI: 0.16-2.09, p = 0.025). Increasing utilization of carbapenems, piperacillin/tazobactam, and Gram-positive agents were seen in the majority of the hospitals, while cephalosporins were less prescribed over time. The combined expenditure for 5 hospitals increased from USD9.9 million in 2006 to USD16.7 million in 2010.
CONCLUSIONS/SIGNIFICANCE: The rate of prescription of broad-spectrum antibiotics in Singaporean hospitals is much higher compared to those of European hospitals. This may be due to high rates of antimicrobial resistance. The increase in expenditure on monitored antibiotics over the past 5 years outstripped the actual increase in DDD/1,000 inpatient-days of antibiotics prescribed. Longitudinal surveillance of antibiotic prescription on a hospital and countrywide level is important for detecting trends for formulating interventions or policies. Further research is needed to understand the causes for the various prescription trends and to act on these where necessary.
抗生素的不合理使用可能导致更高水平的抗菌药物耐药性。改善抗生素合理使用的一个关键干预措施是对处方进行监测。本文介绍了 2006 年至 2010 年期间对新加坡 5 家公立医院广谱抗生素处方进行的纵向监测结果。
方法/主要发现：每季度收集抗生素处方数据，并转换为每 1000 名住院患者的限定日剂量（DDD）。通过回归分析测试了单个和综合医院的抗生素处方随时间的显著趋势，并纠正了时间点之间的自相关。不包括氟喹诺酮类药物，除氟喹诺酮类药物外，所有监测抗生素的处方量均从 2006 年的平均 233.12 DDD/1000 名住院患者增加到 2010 年的 254.38 DDD/1000 名住院患者（系数=1.13，95%CI：0.16-2.09，p=0.025）。大多数医院的碳青霉烯类、哌拉西林/他唑巴坦和革兰阳性药物的使用率都在增加，而头孢菌素类的使用量随着时间的推移而减少。5 家医院的总支出从 2006 年的 990 万美元增加到 2010 年的 1670 万美元。
结论/意义：与欧洲医院相比，新加坡医院广谱抗生素的处方率要高得多。这可能是由于高抗菌药物耐药率。过去 5 年监测抗生素的支出增长超过了实际处方 DDD/1000 名住院患者的增长。对医院和全国范围内的抗生素处方进行纵向监测，对于发现趋势、制定干预措施或政策非常重要。需要进一步研究，以了解各种处方趋势的原因，并在必要时采取行动。
