Grau Santiago, Bou Germán, Fondevilla Esther, Nicolás Jordi, Rodríguez-Maresca Manuel, Martínez-Martínez Luis
Departamento de Farmacia, Hospital del Mar, Barcelona, Spain; Comité VINCat, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain.
Enferm Infecc Microbiol Clin. 2013 Sep;31 Suppl 4:16-24. doi: 10.1016/S0213-005X(13)70128-9.
Collateral damage caused by antibiotic use includes resistance, which could be reduced if the global inappropriate use of antibiotics, especially in low-income countries, could be prevented. Surveillance of antimicrobial consumption can identify and target practice areas for quality improvement, both in the community and in healthcare institutions. The defined daily dose, the usual adult dose of an antimicrobial for treating one patient for one day, has been considered useful for measuring antimicrobial prescribing trends within a hospital. Various denominators from hospital activity including beds, admissions and discharges have been used to obtain some standard ratios for comparing antibiotic consumption between hospitals and countries. Laboratory information systems in Clinical Microbiology Services are the primary resource for preparing cumulative reports on susceptibility testing results. This information is useful for planning empirical treatment and for adopting infection control measures. Among the supranational initiatives on resistance surveillance, the EARS-Net provides information about trends on antimicrobial resistance in Europe. Resistance is the consequence of the selective pressure of antibiotics, although in some cases these agents also promote resistance by favouring the emergence of mutations that are subsequently selected. Multiple studies have shown a relationship between antimicrobial use and emergence or resistance. While in some cases a decrease in antibiotic use was associated with a reduction in resistance rates, in many other situations this has not been the case, due to co-resistance and/or the low biological cost of the resistance mechanisms involved. New antimicrobial agents are urgently needed, which coupled with infection control measures will help to control the current problem of antimicrobial resistance.
抗生素使用造成的附带损害包括耐药性，如果能够防止全球范围内，尤其是低收入国家抗生素的不当使用，耐药性可能会降低。对抗菌药物消费的监测可以确定并针对社区和医疗机构中需要改进质量的实践领域。限定日剂量，即治疗一名患者一天的抗菌药物常用成人剂量，被认为有助于衡量医院内抗菌药物的处方趋势。医院活动的各种分母，包括床位、入院人数和出院人数，已被用来获得一些标准比率，以比较不同医院和国家之间的抗生素消费情况。临床微生物学服务中的实验室信息系统是编制药敏试验结果累积报告的主要资源。这些信息有助于规划经验性治疗和采取感染控制措施。在耐药性监测的超国家倡议中，欧洲抗菌药物耐药性监测网（EARS-Net）提供有关欧洲抗菌药物耐药性趋势的信息。耐药性是抗生素选择性压力的结果，尽管在某些情况下，这些药物也会通过促进随后被选择的突变的出现而导致耐药性。多项研究表明抗菌药物使用与耐药性的出现或产生之间存在关联。虽然在某些情况下，抗生素使用的减少与耐药率的降低有关，但在许多其他情况下并非如此，这是由于共同耐药和/或所涉及的耐药机制的生物学成本较低。迫切需要新型抗菌药物，再加上感染控制措施，将有助于控制当前的抗菌药物耐药性问题。
