a Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen , Aberdeen , UK.
b Department of Medical Microbiology, Aberdeen Royal Infirmary , Aberdeen , UK.
Expert Rev Anti Infect Ther. 2019 Aug;17(8):621-634. doi: 10.1080/14787210.2019.1640602. Epub 2019 Jul 15.
: Inappropriate prescription practices, patient and provider knowledge and attitudes, variable availability of diagnostic and surveillance systems, and the unrestricted use of antimicrobials in animals and plants are contributory factors to the global crisis of antimicrobial resistance (AMR). : Notwithstanding that interventions to revert AMR should be tailored to the socio-politico-economic landscape, there is a global consensus for the implementation and enhancement of antimicrobial stewardship strategies. Yet the implementation of Antimicrobial Stewardship Programs (ASPs) remains relatively limited within healthcare settings and faces complex challenges in resource-limited countries. The current review summarizes the limitations of current ASPs, translation challenges in resource-limited countries, and potential solutions. : Suboptimal ASP implementation in hospitals is multifactorial. Restriction of antimicrobial use should be informed by risk-benefit analyses, including the potential for substitute prescribing, and displacement of selection pressures. Thresholds in population use of antibiotics above which AMR increases may provide quantitative targets for ASPs. Horizontal and vertical collaborations involving policymakers and the general public are of paramount importance. While impactful prescribing changes require sustained engagement of the public and health-care professionals, we warn against over-estimating the benefits of behavioral interventions. We advocate for population-level stewardship interventions in addition to investment in structural factors that will aid ASP implementation.
不适当的处方实践、患者和提供者的知识和态度、诊断和监测系统的可用性变化，以及动植物中抗生素的不受限制使用，都是导致全球抗生素耐药性（AMR）危机的因素。尽管扭转 AMR 的干预措施应该根据社会政治经济情况进行调整，但全球已经达成共识，需要实施和加强抗生素管理策略。然而，在医疗保健环境中，抗生素管理计划（ASPs）的实施仍然相对有限，在资源有限的国家面临着复杂的挑战。目前的综述总结了当前 ASP 的局限性、资源有限国家的翻译挑战以及潜在的解决方案。医院中 ASP 实施不佳是多因素的。限制抗生素的使用应该基于风险效益分析，包括替代处方的可能性以及选择压力的转移。抗生素人群使用的阈值超过该阈值会导致 AMR 增加，这可能为 ASP 提供定量目标。涉及政策制定者和公众的横向和纵向合作至关重要。虽然有影响力的处方改变需要公众和医疗保健专业人员的持续参与，但我们警告不要高估行为干预的好处。我们主张除了投资于有助于 ASP 实施的结构性因素外，还应采取基于人群的管理干预措施。
