Lendowski Luba, Walger Peter, Hoeser Christoph, Exner Martin, Roesing Claudia, Engelhart Steffen
Institut für Hygiene und Öffentliche Gesundheit, Universitätsklinikum Bonn, Bonn.
Innere Medizin, Johanniter-Krankenhaus Bonn GmbH, Bonn.
Gesundheitswesen. 2019 Feb;81(2):82-87. doi: 10.1055/s-0043-109861. Epub 2017 Jun 19.
To combat multi-resistant gram-negative bacteria as the cause of life-threatening infections, antibiotic stewardship activities are of great importance.
To detect weaknesses when prescribing antibiotics in hospitals and compare the situation between 2009 and 2014.
In 2014, a questionnaire was sent to all 380 physicians employed in 7 hospitals. Primary, secondary and tertiary care hospitals were included. Investigated were: demographic data, position, certified specialization, presence of antibiotic prescription rules and behavior to follow them. 119 completed questionnaires of 2014 were compared to 3 613 obtained in 2009.
31% of the questionnaires were returned. 53.8% were interns. Half of these had a certified specialization. 32.8% were consultants and 12.6% were chief physicians. 22.6% were internists, 18.4% surgeons, 10.9% urologists and 9.2% anesthetists. The majority prescribed antibiotics on a daily routine, among the interns 66%. 23% of interns reported they would advise colleagues daily and 61% at least once a week. The most common indications for antibiotic use were antibiotic prophylaxis in surgery (35), urinary tract infection (32) and pneumonia (29). Standard duration of antibiotic therapy reported were 7 days for pneumonia, 5 days for urinary tract infections and 1 day for antibiotic prophylaxis in surgery, while almost 50% of surgeons widened the antibiotic prophylaxis to 3, 5, 7,8 and 10 days. 93.3% physicians reported the use of therapeutic guidelines either from their own hospital or from medical societies. Only 59.3% were provided with the antimicrobial resistance data of their hospital. 52.1% would not ask a consultant for advice before prescribing a broadband antibiotic. Compared to 2009, lack of knowledge about antimicrobial resistance, use of guidelines, and advice from a consultant improved about 5%-points each.
Despite improvement compared to 2009, 38.9% of all physicians asked did not know their regional antibiotic resistant data and half of all surgeons still used surgical prophylaxis longer than 24 h. As the compliance to use guidelines is high with 93.3%, maintenance and development of antibiotic guidelines adjusted to the resistance data is of the greatest importance. Furthermore, antibiotic prophylaxis in surgery longer than 1 day adds to the risks of antibiotics without giving more benefit and must be critically analyzed.
为对抗多重耐药革兰氏阴性菌引发的危及生命的感染，抗生素管理活动至关重要。
检测医院抗生素处方中的薄弱环节，并比较2009年至2014年的情况。
2014年，向7家医院的380名医生发放问卷。涵盖一级、二级和三级医疗机构。调查内容包括：人口统计学数据、职位、专业认证、抗生素处方规则的存在情况以及遵循这些规则的行为。将2014年回收的119份完整问卷与2009年获得的3613份问卷进行比较。
问卷回收率为31%。53.8%为实习医生，其中一半有专业认证。32.8%为顾问医生，12.6%为主治医师。22.6%为内科医生，18.4%为外科医生，10.9%为泌尿科医生，9.2%为麻醉科医生。大多数医生日常都会开具抗生素，实习医生中这一比例为66%。23%的实习医生表示会每天向同事提供建议，61%的实习医生至少每周提供一次建议。使用抗生素最常见的指征是手术中的抗生素预防（35例）、尿路感染（32例）和肺炎（29例）。报告的抗生素标准治疗疗程为肺炎7天、尿路感染5天、手术抗生素预防1天，而近50%的外科医生将手术抗生素预防延长至3、5、7、8和10天。93.3%的医生报告使用了来自自己医院或医学协会的治疗指南。只有59.3%的医生获得了所在医院的抗菌药物耐药数据。52.1%的医生在开具广谱抗生素前不会向顾问医生咨询建议。与2009年相比，对抗菌药物耐药性的了解、指南的使用以及顾问医生的建议各提高了约5个百分点。
尽管与2009年相比有所改善，但所有接受调查的医生中有38.9%不知道所在地区的抗生素耐药数据，所有外科医生中有一半仍将手术预防用药时间延长至超过24小时。由于遵循指南的依从性较高，为93.3%，因此维护和制定根据耐药数据调整的抗生素指南至关重要。此外，手术中超过1天的抗生素预防会增加抗生素风险且无更多益处，必须进行严格分析。
