Healthcare Associated Infections and Antimicrobial Resistance Team, Public Health Strategy Division, Health Protection Agency, London NW9 5HT, UK.
J Antimicrob Chemother. 2012 Jul;67 Suppl 1:i51-63. doi: 10.1093/jac/dks202.
There has been dramatic change in antibiotic use in English hospitals. Data from 2004 and 2009 show that the focus on reducing fluoroquinolone and second- and third-generation cephalosporin use seems to have been heeded in NHS secondary care, and has been associated with a substantial decline in hospital Clostridium difficile rates. However, there has been a substantial increase in use of co-amoxiclav, carbapenems and piperacillin/tazobactam. In primary care, antibiotic prescribing fell markedly from 1995 to 2000, but has since risen steadily to levels seen in the early 1990s. There remains a 2-fold variation in antimicrobial prescribing among English General Practices. In 2010, the NHS Atlas of Variation documented a 3-fold variation in the prescription of quinolones and an 18-fold variation in cephalosporins by Primary Care Trusts across England. There is a clear need to improve antimicrobial prescribing. This paper describes the development of new antimicrobial stewardship programmes for primary care and hospitals by the Department of Health's Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection: Antimicrobial Stewardship in Primary Care Initiative. The secondary care programme promotes the rapid prescription of the right antibiotic at the right dose at the right time, followed by active review for all patients still on antibiotics 48 h after admission. The five options available are to stop, switch to oral, continue and review again, change (if possible to a narrower spectrum) or move to outpatient parenteral antibiotic therapy. A range of audit and outcome tools has been developed, but to maintain optimal antimicrobial usage, monitoring of local and national quantitative and qualitative data on prescribing and consumption is required, linked to the development of key performance indicators in primary, secondary and tertiary care.
英国医院的抗生素使用情况发生了巨大变化。2004 年和 2009 年的数据显示，在国民保健制度的二级保健中，减少氟喹诺酮类药物和第二代和第三代头孢菌素类药物的使用的重点似乎已经得到重视，这与医院艰难梭菌感染率的大幅下降有关。然而，碳青霉烯类、哌拉西林/他唑巴坦和复方新诺明的使用量却大幅增加。在初级保健中，抗生素的处方量从 1995 年到 2000 年显著下降，但此后稳步上升，达到 20 世纪 90 年代初的水平。英国普通实践中的抗生素处方仍存在 2 倍的差异。2010 年，NHS 变异图集记录了英格兰各地的初级保健信托机构在喹诺酮类药物的处方方面存在 3 倍的差异，在头孢菌素类药物的处方方面存在 18 倍的差异。显然需要改进抗生素的使用。本文描述了卫生署抗菌药物耐药性和医疗保健相关感染咨询委员会为初级保健和医院制定的新抗菌药物管理计划：初级保健抗菌药物管理倡议。二级保健方案促进在适当的时间以适当的剂量快速开处方合适的抗生素，然后对所有入院 48 小时后仍在使用抗生素的患者进行积极审查。有五种选择：停止、改为口服、继续并再次审查、更改（如果可能改为更窄谱）或转为门诊肠外抗生素治疗。已经开发了一系列的审计和结果工具，但为了保持最佳的抗菌药物使用，需要监测当地和全国关于处方和使用的数据的数量和质量，并将其与主要、次要和 tertiary care 的关键绩效指标的制定联系起来。
