Antoniadou Anastasia, Kanellakopoulou Kyriaki, Kanellopoulou Maria, Polemis Michael, Koratzanis George, Papademetriou Evangelia, Poulakou Garyfalia, Giannitsioti Efthimia, Souli Maria, Vatopoulos Alkiviadis, Giamarellou Helen
Fourth Department of Internal Medicine, University General Hospital Attikon, Greece.
Scand J Infect Dis. 2013 Jun;45(6):438-45. doi: 10.3109/00365548.2012.760845. Epub 2013 Jan 22.
To evaluate the impact of an antibiotic restriction policy on antibiotic consumption and Gram-negative resistance rates, in an environment of antibiotic overconsumption and increasing resistance rates for nosocomial pathogens.
The study was a 'before and after' trial of 18-month duration; the antibiotic restriction policy program was implemented in 1998-2000 and was based on a government program addressed by the Ministry of Health to public hospitals on a national basis. This included prescribing of all newer antibiotics on an order form, auditing of the order forms and consultation with infectious diseases (ID) specialists, dispensing of treatment and prophylaxis guidelines, feedback, and face-to-face education. Antibiotic consumption and Gram-negative resistance rates were recorded before and after the intervention.
Despite the addition of a new 40-bed ID department in the hospital during the 'after' period, the consumption of restricted antibiotics was significantly reduced by 42% (and their cost by 31%). Gram-negative resistance rates for Pseudomonas, Klebsiella, and Enterobacter, serving as index microorganisms for Gram-negative nosocomial pathogens, were significantly reduced during the 'after' period, even against antibiotics for which there was an increase in consumption.
Multidisciplinary restriction programs can reduce antibiotic consumption and Gram-negative resistance rates in the hospital setting.
在医院病原体抗生素过度使用及耐药率上升的环境下，评估抗生素限制政策对抗生素使用及革兰阴性菌耐药率的影响。
本研究为一项为期18个月的“前后对照”试验；抗生素限制政策项目于1998 - 2000年实施，基于卫生部向全国公立医院发布的一项政府项目。这包括通过订单形式开具所有新型抗生素、审核订单并咨询传染病（ID）专家、发放治疗和预防指南、反馈以及面对面教育。在干预前后记录抗生素使用情况和革兰阴性菌耐药率。
尽管在“后”期医院新增了一个拥有40张床位的ID科室，但受限抗生素的使用量显著降低了42%（其成本降低了31%）。作为革兰阴性医院病原体指示微生物的铜绿假单胞菌、克雷伯菌和肠杆菌的革兰阴性菌耐药率在“后”期显著降低，即使是针对使用量有所增加的抗生素。
多学科限制项目可降低医院环境中的抗生素使用量及革兰阴性菌耐药率。
