Demoré Béatrice, Humbert Pauline, Boschetti Emmanuelle, Bevilacqua Sibylle, Clerc-Urmès Isabelle, May Thierry, Pulcini Céline, Thilly Nathalie
Pharmacy, Brabois Hospital, University Hospital of Nancy, Allée du Morvan, 54511, Vandoeuvre-lès-Nancy, France.
Faculté de Pharmacie, UMR 7565, SRSMC, CNRS - Lorraine University, Rue Albert Lebrun, 54001, Nancy Cedex, France.
Int J Clin Pharm. 2017 Oct;39(5):1061-1069. doi: 10.1007/s11096-017-0516-5. Epub 2017 Jul 29.
Background Antibiotic-resistant bacteria are a major public health problem throughout the world. In 2006, in accordance with the national guidelines for antibiotic use, the CHRU of Nancy created an operational multidisciplinary antibiotic team at one of its sites. In 2011, a cluster-controlled trial showed that the operational multidisciplinary antibiotic team (the intervention) had a favourable short-term effect on antibiotic use and costs. Objective Our objective was to determine whether these effects continued over the medium to long term (that is, 2-7 years after creation of the operational multidisciplinary antibiotic team, 2009-2014). Setting The 1800-bed University Hospital of Nancy (France). Method The effect in the medium to long term is measured according to the same criteria and assessed by the same methods as the first study. A cluster controlled trial was performed on the period 2009-2014. The intervention group comprised 11 medical and surgical wards in settings where the operational multidisciplinary antibiotic team was implemented and the control group comprised 6 wards without this operational team. Main outcome measure Consumption of antibiotics overall and by therapeutic class (in defined daily doses per 1000 patient-days) and costs savings (in €). Results The reduction in antibiotic use and costs continued, but at a lower rate than in the short term (11% between 2009 and 2014 compared with 33% between 2007 and 2009) at the site of the intervention. The principal decreases concerned fluoroquinolones and glycopeptides. At the site without an operational multidisciplinary antibiotic team (the control group), total antibiotic use remained stable. Between 2009 and 2014, costs fell 10.5% in the intervention group and 5.7% in the control group. Conclusion This study shows that it is possible to maintain the effectiveness over time of such an intervention and demonstrates its role in defining a hospital's antibiotic policy.
背景 耐抗生素细菌是全球主要的公共卫生问题。2006年，南锡大学医院中心（CHRU）依据国家抗生素使用指南，在其一个院区组建了一支多学科抗生素工作小组。2011年，一项整群对照试验表明，多学科抗生素工作小组（干预措施）在抗生素使用和成本方面具有良好的短期效果。目的 我们的目的是确定这些效果在中长期（即多学科抗生素工作小组成立后的2至7年，2009 - 2014年）是否持续存在。地点 拥有1800张床位的法国南锡大学医院。方法 中长期效果按照与第一项研究相同的标准进行衡量，并采用相同的方法进行评估。在2009 - 2014年期间开展了一项整群对照试验。干预组包括11个实施了多学科抗生素工作小组的内科和外科病房，对照组包括6个未设立该工作小组的病房。主要观察指标 总体抗生素消耗量及按治疗类别划分的消耗量（以每1000患者日的限定日剂量计）以及成本节约情况（以欧元计）。结果 在干预院区，抗生素使用量和成本的降低仍在持续，但速度低于短期（2009年至2014年期间降低了11%，而2007年至2009年期间为33%）。主要降幅涉及氟喹诺酮类和糖肽类药物。在未设立多学科抗生素工作小组的院区（对照组），抗生素总使用量保持稳定。2009年至2014年期间，干预组成本下降了10.5%，对照组下降了5.7%。结论 本研究表明，此类干预措施的效果能够随时间得以维持，并证明了其在制定医院抗生素政策方面的作用。
