西班牙加泰罗尼亚地区急症医院经验性使用碳青霉烯类药物的情况普遍增加。
Widespread increase of empirical carbapenem use in acute care hospitals in Catalonia, Spain.
作者信息
Grau Santiago, Fondevilla Esther, Echeverría-Esnal Daniel, Alcorta Amaia, Limon Enric, Gudiol Francesc
机构信息
Member of the VINCat Committee, Department of Health, Catalonia, Spain; Pharmacy Department, Hospital Del Mar, Barcelona, Spain.
VINCat Coordinating Centre, Feixa Llarga sn, Facultat de Medicina, Departament de Ciències Clíniques, Barcelona, Spain.
出版信息
Enferm Infecc Microbiol Clin (Engl Ed). 2019 Jan;37(1):36-40. doi: 10.1016/j.eimc.2018.03.003. Epub 2018 Apr 24.
INTRODUCTION
The overall increase in the use of carbapenems could lead to the selection of carbapenem-resistant bacteria. The objectives of this study were to analyze carbapenem use from 2008 to 2015 and their prescription profile in 58 hospitals affiliated to the VINCat Programme (nosocomial infection vigilance system).
METHODS
Retrospective, longitudinal and descriptive study of carbapenem use. Consecutive case-series study, looking for carbapenem prescription characteristics, conducted in January 2016. Use was calculated in defined daily doses (DDD)/100 patient-days (PD); prescription profiles were assessed using a standardized survey.
RESULTS
Carbapenem use increased 88.43%, from 3.37 DDD/100-PD to 6.35 DDD/100-PD (p<0.001). A total of 631 patients were included in the prescription analysis. Carbapenems were prescribed empirically in 76.2% of patients, mainly for urinary tract and intra-abdominal infections due to suspicion of polymicrobial mixed infection (27.4%) and severity (25.4%).
CONCLUSION
A worrying increase in carbapenem use was found in Catalonia. Stewardship interventions are required to prevent carbapenem overuse.
引言
碳青霉烯类药物使用的总体增加可能导致耐碳青霉烯类细菌的产生。本研究的目的是分析2008年至2015年期间碳青霉烯类药物的使用情况及其在VINCat计划（医院感染监测系统）所属的58家医院中的处方概况。
方法
对碳青霉烯类药物的使用进行回顾性、纵向和描述性研究。2016年1月进行连续病例系列研究，以寻找碳青霉烯类药物的处方特征。使用限定日剂量（DDD）/100患者日（PD）来计算使用量；使用标准化调查评估处方概况。
结果
碳青霉烯类药物的使用增加了88.43%，从3.37 DDD/100-PD增至6.35 DDD/100-PD（p<0.001）。共有631名患者纳入处方分析。76.2%的患者接受了经验性碳青霉烯类药物治疗，主要用于怀疑有多种微生物混合感染（27.4%）和病情严重（25.4%）导致的尿路感染和腹腔内感染。
结论
加泰罗尼亚地区碳青霉烯类药物的使用出现了令人担忧的增长。需要采取管理干预措施以防止碳青霉烯类药物的过度使用。
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