Olsen Markus Harboe, Anhøj Jacob, Knudsen Jenny Dahl, Frimodt-Møller Niels, Møller Kirsten
Department of Neuroanaesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Centre of Diagnostic Investigation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
APMIS. 2019 Jan;127(1):33-40. doi: 10.1111/apm.12909.
Hospitals worldwide are working on minimizing unnecessary use of antimicrobials. To assess actual changes of antimicrobial usage, correct and precise measurements are necessary. This study aimed to compare data on the purchase of antibiotics from the pharmacy and the administration of antibiotics to patients, respectively, in an intensive care unit (ICU). Data were obtained from the Neurointensive Care Unit (NICU) at Rigshospitalet, Denmark. During a 23-month period, comprising 10 770 bed-days (BD), the ward purchased 16 908 defined daily doses (DDD) of antibiotics from the pharmacy, and 15 130 DDD and 41 304 individual doses were administered. Intraclass correlation coefficients (ICCs) were calculated; control and runcharts and a Bland-Altman plot were constructed. Pharmacy sales and drug administration data showed no systematic variation over time with a monthly overestimation of pharmacy sales data of 10% (95% confidence interval (CI), 6.20-14.3%) for all antibiotics, and 7% (95% CI: 1.81-11.1%) for broad-spectrum antibiotics. The antibiotic consumption, without bed-days, has a clinically acceptable ICC of >0.70 and no systematic difference is suggested by the Bland-Altman plot. In this study of a large NICU, whose antibiotic consumption varied at random, pharmacy sales data were an acceptable approximation of the actual summarized drug consumption.
全球各地的医院都在努力减少抗菌药物的不必要使用。为了评估抗菌药物使用的实际变化，准确精确的测量是必要的。本研究旨在比较重症监护病房（ICU）中分别从药房购买抗生素的数据和给患者使用抗生素的数据。数据来自丹麦里格霍斯皮塔利特医院的神经重症监护病房（NICU）。在为期23个月的时间里，该病房共10770个床日（BD），从药房购买了16908限定日剂量（DDD）的抗生素，使用了15130 DDD和41304单剂量。计算了组内相关系数（ICC）；构建了控制图和运行图以及布兰德-奥特曼图。药房销售数据和药物使用数据显示，随时间没有系统变化，所有抗生素的药房销售数据每月高估10%（95%置信区间（CI），6.20 - 14.3%），广谱抗生素为7%（95% CI：1.81 - 11.1%）。不考虑床日的抗生素消耗量具有临床可接受的ICC>0.70，布兰德-奥特曼图未显示出系统差异。在这项对大型NICU的研究中，其抗生素消耗量随机变化，药房销售数据是实际汇总药物消耗量的可接受近似值。
