Bonsignore M, Balamitsa E, Nobis C, Tafelski S, Geffers C, Nachtigall I
Zentrum für Hygiene, Evangelische Kliniken Gelsenkirchen, Munkelstr. 27, 45879, Gelsenkirchen, Deutschland.
Klinik für Innere Medizin, Evangelische Kliniken Gelsenkirchen, Gelsenkirchen, Deutschland.
Anaesthesist. 2018 Jan;67(1):47-55. doi: 10.1007/s00101-017-0399-9.
In response to the global increase in antibiotic resistance, the concept of antibiotic stewardship (ABS) has become increasingly important in recent years. Several publications have demonstrated the effectiveness of ABS, mainly in university facilities. This retrospective observational study describes the implementation of ABS in a basic care hospital.
Following existing national guidelines, an ABS team was set up and measures were launched. These included: hospital guidelines, teaching, weekly antibiotic ward rounds and the restriction of definite substances. The preinterventional/postinterventional data analysis compared the use of antibiotics and blood culture sets as well as the development of resistance, infection with Clostridium difficile (CDI), costs, mortality and length of hospital stay.
The measures introduced led to a significant and continuous decline in total antibiotic use of initially 43 recommended daily doses (RDD)/100 patient days (PD) to 31 RDD/100 PD (p < 0.001). The largest decrease was observed in second generation (2G) cephalosporins (-67.5%), followed by 3G cephalosporins (-52.7%), carbapenems (-42.0%) and quinolones (-38.5%). The resistance rate of E. coli to 3G cephalosporins in blood cultures decreased from 26% to 9% (p = 0.021). The rate of blood cultures taken increased from 1.8 sets/100 PD to 3.2 sets/100 PD (+77%, p < 0.001). The pathogen detection rate, defined as one count when a minimum of one sample taken in a day is positive, also increased significantly from 4.0/1000 PD to 6.8/1000 PD (p < 0.001). The ABS had no effect on the overall mortality, the mean dwell time, and the preintervention low CDI incidence.
The preinterventional/postinterventional comparison showed a significant reduction in the overall consumption of antibiotics with a redistribution in favor of antibiotics with a lower resistance selection. At the same time, the resistance rate of E. coli decreased. The increase of the blood culture rate indicates the optimization of diagnostic procedures. This ABS program had to be established with reduced resources but this seems to have been compensated by the more personal contact addressing the care takers and short chain of commands, as is possible in smaller hospitals. Presumably, the structure of basic care hospitals is particularly suitable for concepts covering entire hospitals. Further clusters of randomized studies are necessary to confirm this.
为应对全球抗生素耐药性的增加，抗生素管理（ABS）的概念近年来变得越来越重要。一些出版物已证明了ABS的有效性，主要是在大学设施中。这项回顾性观察研究描述了一家基层护理医院中ABS的实施情况。
遵循现有的国家指南，成立了一个ABS团队并启动了相关措施。这些措施包括：医院指南、教学、每周抗生素病房巡查以及对特定药物的限制。干预前/干预后数据分析比较了抗生素和血培养瓶的使用情况以及耐药性的发展、艰难梭菌感染（CDI）、成本、死亡率和住院时间。
所采取的措施使抗生素总使用量从最初的43规定日剂量（RDD）/100患者日（PD）显著且持续下降至31 RDD/100 PD（p < 0.001）。第二代（2G）头孢菌素的降幅最大（-67.5%），其次是第三代（3G）头孢菌素（-52.7%）、碳青霉烯类（-42.0%）和喹诺酮类（-38.5%）。血培养中大肠杆菌对3G头孢菌素的耐药率从26%降至9%（p = 0.021）。血培养瓶的采集率从1.8瓶/100 PD增至3.2瓶/100 PD（+77%，p < 0.001）。病原体检测率（定义为一天内至少采集的一个样本呈阳性时计为一次）也从4.0/1000 PD显著增至6.8/1000 PD（p < 0.001）。ABS对总体死亡率、平均住院时间以及干预前较低的CDI发病率没有影响。
干预前/干预后比较显示抗生素总消耗量显著减少，且有利于耐药性选择较低的抗生素的重新分配。同时，大肠杆菌的耐药率下降。血培养率的增加表明诊断程序得到了优化。该ABS项目是在资源减少的情况下建立的，但这似乎已通过与护理人员更多的个人接触以及较短的指挥链（这在较小的医院中是可能的）得到了弥补。据推测，基层护理医院的结构特别适合涵盖整个医院的理念。需要进一步开展随机研究集群来证实这一点。
