Tonna A P, Gould I M, Stewart D
School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK.
J Clin Pharm Ther. 2014 Oct;39(5):516-20. doi: 10.1111/jcpt.12181. Epub 2014 May 29.
Antimicrobial stewardship programmes describe strategies to optimize antimicrobial prescribing and utilization, minimize resistance and improve patient outcomes. Strategies in hospitals are usually implemented by multidisciplinary antimicrobial teams (AMTs). The objective of this study was to describe the profile and activities of AMTs within hospitals in the United Kingdom (UK).
All hospitals within the UK (n = 836) were included, and a prepiloted questionnaire was mailed to the 'Director of Pharmacy'. Non-respondents were mailed up to two reminder questionnaires at two-weekly intervals. Main outcome measures are as follows: existence and remit of the AMTs; availability of antimicrobial-prescribing policies, aims, scope and methods of dissemination; and monitoring and feedback provided on antimicrobial policy adherence.
Response rate was 33% (n = 273). Completed questionnaires analysed were n = 226. Eighty-two (n = 186) of respondents indicated the presence of an AMT within the hospital, with 95% of these (n = 177) reporting an antimicrobial pharmacist as part of the team. All AMTs (n = 186) were involved in development of an antimicrobial policy and almost all (99% n = 184) promoted adherence and restricting use of specific antimicrobials (97% n = 180). Ninety-eight per cent of respondents (n = 222) reported the availability of a local antimicrobial-prescribing policy within the hospital with this disseminated mainly through the hospital intranet (98% n = 217). Adherence to policy was measured mainly through audits measuring the appropriateness of antimicrobial use against the local policy (76% n = 169). Hospitals in England (P = 0·010), tertiary care hospitals (P = 0·021) and bed capacity >500 (P < 0·001) were more likely to have an AMT, as were hospitals with an accident and emergency department (P < 0·001), an infectious diseases unit (P = 0·019) and a microbiology department (P < 0·001). Audits to measure policy adherence were more likely (P < 0·001) if an AMT was present. The only variable retained in bivariate logistic regression was the presence of a microbiology unit, with an odds ratio of 14·1 (95% CI 6·02-33·33, P < 0·001).
Although most respondents reported an antimicrobial-prescribing policy, less had an AMT. Despite recent government and regional initiatives, further improvements in antimicrobial stewardship are still required.
抗菌药物管理计划描述了优化抗菌药物处方和使用、最小化耐药性并改善患者治疗效果的策略。医院中的策略通常由多学科抗菌药物团队（AMT）实施。本研究的目的是描述英国医院内抗菌药物团队的概况和活动。
纳入英国所有医院（n = 836），并向“药剂科主任”邮寄一份预先试点的问卷。未回复者每隔两周邮寄至多两份提醒问卷。主要观察指标如下：抗菌药物团队的存在情况和职责范围；抗菌药物处方政策的可用性、目标、范围和传播方法；以及针对抗菌药物政策依从性的监测和反馈。
回复率为33%（n = 273）。分析的完整问卷有n = 226份。82%（n = 186）的受访者表示医院内存在抗菌药物团队，其中95%（n = 177）报告团队中有抗菌药物药师。所有抗菌药物团队（n = 186）都参与了抗菌药物政策的制定，几乎所有团队（99%，n = 184）都促进了特定抗菌药物的依从性并限制其使用（97%，n = 180）。98%的受访者（n = 222）报告医院内有当地抗菌药物处方政策，且主要通过医院内部网进行传播（98%，n = 217）。政策依从性主要通过根据当地政策评估抗菌药物使用适宜性的审核来衡量（76%，n = 169）。英格兰的医院（P = 0.010）、三级护理医院（P = 0.021）以及床位容量>500的医院（P < 0.001）更有可能拥有抗菌药物团队，设有急诊科（P < 0.001）、传染病科（P = 0.019）和微生物科的医院（P < 0.001）也是如此。如果存在抗菌药物团队，进行政策依从性审核的可能性更大（P < 0.001）。二元逻辑回归中保留的唯一变量是微生物科的存在情况，比值比为14.1（95%可信区间6.02 - 33.33，P < 0.001）。
尽管大多数受访者报告有抗菌药物处方政策，但拥有抗菌药物团队的较少。尽管最近有政府和地区层面的举措，但抗菌药物管理仍需进一步改进。
