Otto Cornelia, Hirl Bertrand, Schweitzer Stefan, Gleich Sabine
Abteilung Hygiene und Umweltmedizin, Referat für Gesundheit und Umwelt, Bayerstraße 28a, 80335, München, Deutschland.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2016 Dec;59(12):1549-1555. doi: 10.1007/s00103-016-2461-1.
On 4 August 2011 a modification of the infection protection act became law, meaning that antibiotic consumption surveillance and evaluation of data on the local resistance situation became obligatory for hospitals. Four years after the modification of the infection protection act became law, the Munich public health department aimed to evaluate the state of implementation of antibiotic consumption surveillance in Munich hospitals and to ascertain which antibiotic stewardship (ABS) structures have already been established.
A questionnaire was sent to Munich hospitals about their antibiotic management structural data and state of implementation of legal requirements.
Only 32 % of the hospitals have qualified ABS-experts available. In 76 % of the hospitals persons responsible for antibiotic consumption surveillance are appointed, while in 12 % persons responsible for antibiotic consumption surveillance are at least partly released from their normal work for this activity. Twenty-one hospitals (21 %) conduct antibiotic consumption surveillance taking into account all antiinfective agents mentioned in the Robert Koch-Institute (RKI) guidelines. Of these, 19 (76 %) did this on basis of World Health Organizations ATC/DDD-system (anatomical therapeutic chemical [ATC] classification system which uses defined daily doses [DDD]). The data on antibiotic consumption is evaluated in 72 % of the hospitals, 68 % take account of the local resistance situation. In 96 %, in-house lists of antiinfectives are available; in 80 %, in-house guidelines for antibiotic treatment are available. Fourty-four percent of the hospitals take part in a national surveillance.
For the first time data were collected on implementation of antibiotic consumption surveillance in hospitals, which has been required by law since 2011. An incomplete implementation of legal requirements was demonstrated. It was found that structural and personnel prerequisites are often missing, that release from normal work for this additional duty is rarely granted and that the evaluation of data is often either missing or does not correspond to the legal requirements by omitting to take account of the local resistance situation. The hygienic control of hospitals by the public health service was extended by an additional subject. To carry out this very specialized task in a competent way, an ABS-qualification for public health staff is essential from the perspective of the authors.
2011年8月4日，《感染保护法》的一项修订案成为法律，这意味着医院有义务开展抗生素消费监测并评估当地耐药情况的数据。在《感染保护法》修订案成为法律四年后，慕尼黑公共卫生部门旨在评估慕尼黑各医院抗生素消费监测的实施状况，并确定已经建立了哪些抗生素管理（ABS）结构。
向慕尼黑各医院发送了一份问卷，询问其抗生素管理结构数据和法律要求的实施状况。
只有32%的医院有合格的ABS专家。76%的医院指定了负责抗生素消费监测的人员，而12%的医院负责抗生素消费监测的人员至少部分地从其日常工作中抽身出来从事这项活动。21家医院（21%）在开展抗生素消费监测时考虑了罗伯特·科赫研究所（RKI）指南中提及的所有抗感染药物。其中，19家医院（76%）是基于世界卫生组织的ATC/DDD系统（采用限定日剂量[DDD]的解剖学治疗学化学[ATC]分类系统）进行的。72%的医院对抗生素消费数据进行评估，68%的医院考虑了当地的耐药情况。96%的医院有内部抗感染药物清单；80%的医院有内部抗生素治疗指南。44%的医院参与了全国性监测。
首次收集了自2011年起法律要求的医院抗生素消费监测实施情况的数据。结果表明法律要求的实施情况并不完整。发现结构和人员方面的先决条件往往缺失，很少有人因这项额外职责而从日常工作中抽身，而且数据评估往往缺失，或者由于未考虑当地耐药情况而不符合法律要求。公共卫生服务对医院的卫生监督增加了一个额外的主题。从作者的角度来看，要以胜任的方式开展这项非常专业的任务，公共卫生工作人员具备ABS资质至关重要。
