Leung Valerie, Li Michael, Wu Julie Hui-Chih, Langford Bradley, Zvonar Rosemary, Powis Jeff, Longpre Julie, Béïque Lizanne, Gill Suzanne, Ho Grace, Garber Gary
Infection Prevention and Control, Public Health Ontario.
Leslie Dan Faculty of Pharmacy, University of Toronto.
Open Forum Infect Dis. 2018 May 24;5(6):ofy110. doi: 10.1093/ofid/ofy110. eCollection 2018 Jun.
Antimicrobial stewardship, a key component of an overall strategy to address antimicrobial resistance, has been recognized as a global priority. The ability to track and benchmark antimicrobial use (AMU) is critical to advancing stewardship from an organizational and provincial perspective. As there are few comprehensive systems in Canada that allow for benchmarking, Public Health Ontario conducted a pilot in 2016/2017 to assess the feasibility of using a point prevalence methodology as the basis of a province-wide AMU surveillance program.
Three acute care hospitals of differing sizes in Ontario, Canada, participated. Adults admitted to inpatient acute care beds on the survey date were eligible for inclusion; a sample size of 170 per hospital was targeted, and data were collected for the 24-hour period before and including the survey date. Debrief sessions at each site were used to gather feedback about the process. Prevalence of AMU and the Antimicrobial Spectrum Index (ASI) was reported for each hospital and by indication per patient case.
Participants identified required improvements for scalability including streamlining ethics, data sharing processes, and enhancing the ability to compare with peer organizations at a provincial level. Of 457 patients, 172 (38%) were receiving at least 1 antimicrobial agent. Beta-lactam/beta-lactamase inhibitors were the most common (18%). The overall mean ASI per patient was 6.59; most cases were for treatment of infection (84%).
This pilot identified factors and features required for a scalable provincial AMU surveillance program; future efforts should harmonize administrative processes and enable interfacility benchmarking.
抗菌药物管理是应对抗菌药物耐药性总体战略的关键组成部分，已被视为全球优先事项。从组织和省级层面推进抗菌药物管理，追踪和衡量抗菌药物使用（AMU）的能力至关重要。由于加拿大很少有全面的系统可用于进行基准对比，安大略省公共卫生部门在2016/2017年开展了一项试点，以评估使用点患病率方法作为全省抗菌药物使用监测计划基础的可行性。
加拿大安大略省三家不同规模的急性护理医院参与了研究。调查当日入住急性护理病房的成年患者符合纳入条件；每家医院的目标样本量为170例，并收集调查日期前24小时（含调查日期）的数据。在每个研究地点召开汇报会，以收集对该过程的反馈。报告了每家医院以及每位患者病例按适应证分类的抗菌药物使用患病率和抗菌谱指数（ASI）。
参与者确定了在扩大规模方面需要改进的地方，包括简化伦理、数据共享流程，以及增强在省级层面与同行机构进行比较的能力。在457例患者中，172例（38%）正在接受至少一种抗菌药物治疗。β-内酰胺/β-内酰胺酶抑制剂最为常见（18%）。每位患者的总体平均ASI为6.59；大多数病例用于治疗感染（84%）。
该试点确定了可扩展的省级抗菌药物使用监测计划所需的因素和特征；未来的工作应统一管理流程并实现机构间的基准对比。
