Leung Valerie, Wu Julie Hui-Chih, Langford Bradley J, Garber Gary
Affiliations: Public Health Ontario (Leung, Wu, Langford, Garber); Department of Medicine (Garber), University of Toronto, Toronto, Ont.
CMAJ Open. 2018 Feb 2;6(1):E71-E76. doi: 10.9778/cmajo.20170111.
Antimicrobial resistance is an important public health issue globally and in Canada. To understand the current state of antimicrobial stewardship programs in Ontario health care facilities, Public Health Ontario conducted a voluntary survey of hospitals in the province.
The Ontario Antimicrobial Stewardship Program Landscape Survey was distributed online to hospitals, targeting front-line antimicrobial stewardship clinicians. The survey was open for 5 weeks in fall 2016. We used email and telephone reminders to encourage response. We performed descriptive and inferential statistical analyses at an aggregate level and by hospital type. Mental health and ambulatory sites were excluded.
The response rate was 74.0% (97/131 organizations). Of the 97, 90 (93%) reported having a formal antimicrobial stewardship program or were in the process of implementing a formal program. Just over half (50 [56%]) identified appropriate antibiotic use as part of the organization's quality-improvement plan, strategic goal or priority. Half (45 [50%]) of programs did not have designated resources; those that did are underresourced with respect to physician and pharmacist staffing. The scope of implementation of program strategies was variable. Fifty hospitals (56%) reported tracking antimicrobial expenditures, 47 (52%) reported tracking defined daily dose, and 35 (39%) reported tracking days of therapy.
Most Ontario hospitals have a formal antimicrobial stewardship program, but there are opportunities for improvement. Future efforts should increase the priority of and improve resource allocation for antimicrobial stewardship programs so that programs can continue to grow in scope and impact.
抗菌药物耐药性是全球及加拿大的一个重要公共卫生问题。为了解安大略省医疗机构抗菌药物管理计划的现状，安大略省公共卫生部门对该省医院进行了一项自愿调查。
安大略省抗菌药物管理计划概况调查通过网络分发给医院，目标对象为一线抗菌药物管理临床医生。该调查于2016年秋季开放5周。我们通过电子邮件和电话提醒来鼓励回复。我们在总体层面以及按医院类型进行了描述性和推断性统计分析。排除了心理健康机构和门诊场所。
回复率为74.0%（97/131个组织）。在这97个组织中，90个（93%）报告有正式的抗菌药物管理计划或正在实施正式计划。略超过一半（50个[56%]）将合理使用抗生素确定为组织质量改进计划、战略目标或优先事项的一部分。一半（45个[50%]）的计划没有指定资源；有资源的计划在医生和药剂师人员配备方面资源不足。计划策略的实施范围各不相同。50家医院（56%）报告跟踪抗菌药物支出，47家（52%）报告跟踪限定日剂量，35家（39%）报告跟踪治疗天数。
安大略省的大多数医院都有正式的抗菌药物管理计划，但仍有改进空间。未来的努力应提高抗菌药物管理计划的优先级并改善资源分配，以便这些计划能够在范围和影响上持续发展。
