Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA.
Pharmacotherapy. 2012 Aug;32(8):668-76. doi: 10.1002/j.1875-9114.2012.01163.x.
Hospitals are implementing antimicrobial stewardship programs (ASPs) in response to national guidelines to improve the use and to extend the utility of antiinfective drugs. An often implied purpose of ASPs is to curb or reverse the emergence of resistant bacteria. Because antibiotic use causes antibiotic resistance, there is a natural tendency to link local measures of antibiotic use to local measures of bacterial resistance, and the hospital antibiogram is a readily available measure of resistance. We performed a literature review to identify published reports that used hospitalwide and unit-specific antibiograms to assess the relationship of ASP interventions to changes in resistance. Eight studies were identified and reviewed. The relationship between hospital antibiotic use and resistance is complex, and the existing literature has several limitations. Furthermore, the antibiogram itself is neither designed nor well suited to reflect changes in hospital antimicrobial drug use. The literature on the effectiveness of ASPs in reducing resistance continues to emerge, but at this time the antibiogram bears an inconsistent relationship with changes in hospital antibiotic use and cannot be recommended to reliably evaluate an ASP intervention. Interrupted time series analysis is a superior strategy to assess the effect of an ASP intervention on bacterial resistance, but it is not widely used because of its complexity and greater data requirements. Nevertheless, before ASP efforts can be convincingly demonstrated to have a favorable impact on resistance, a more sophisticated approach that links drug use to resistance should become a priority, at least for hospitals that have sufficient resources.
医院正在实施抗菌药物管理计划 (ASPs)，以响应国家指南，改善抗感染药物的使用并扩大其用途。ASPs 的一个常隐含的目的是遏制或逆转耐药细菌的出现。由于抗生素的使用会导致抗生素耐药性，因此人们自然倾向于将局部抗生素使用措施与局部细菌耐药性措施联系起来，而医院抗生素谱图是一种现成的耐药性衡量标准。我们进行了文献回顾，以确定使用全院和特定单位抗生素谱图来评估 ASP 干预与耐药性变化之间关系的已发表报告。确定并审查了八项研究。医院抗生素使用与耐药性之间的关系很复杂，现有文献存在几个局限性。此外，抗生素谱图本身既不是为反映医院抗菌药物使用变化而设计的，也不太适合反映这种变化。关于 ASP 降低耐药性效果的文献仍在不断涌现，但目前抗生素谱图与医院抗生素使用变化之间的关系不一致，因此不能推荐其用于可靠地评估 ASP 干预措施的效果。中断时间序列分析是评估 ASP 干预对细菌耐药性影响的一种优越策略，但由于其复杂性和更高的数据要求，并未得到广泛应用。然而，在 ASP 努力能够令人信服地证明对抗耐药性具有有利影响之前，应该优先采用一种更复杂的方法，将药物使用与耐药性联系起来，至少对于那些有足够资源的医院应该这样做。
