尼日利亚北部住院患者的抗生素使用情况：一项多中心时点患病率调查。
Antibiotic use among hospitalized patients in northern Nigeria: a multicenter point-prevalence survey.
机构信息
Pharmacy Department, Ibrahim Badamasi Babangida (IBB) Specialist Hospital, Minna, Niger, Nigeria.
出版信息
BMC Infect Dis. 2020 Jan 30;20(1):86. doi: 10.1186/s12879-020-4815-4.
BACKGROUND
The evaluation of antibiotic use among hospitalized patients is a primary step required to design antibiotic stewardship intervention. There is paucity of data describing antibiotic use in hospitals across Northern Nigeria. This study evaluates the prevalence and indications for antibiotic use among inpatients in three acute care hospitals.
METHODS
A point-prevalence survey was conducted among patients in the wards before or at 8.00 a.m. on the day of the survey, using the point-prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals protocol. The survey was conducted between April and May 2019. The medical records of the patients were reviewed by a clinical pharmacist with the support of physicians and nurses.
RESULTS
Overall, 80.1% (257/321) of the patients used at least one antibiotic on the day of the survey. The prevalence of antibiotic use ranged from 72.9% in obstetrics and gynecology to 94.6% in pediatric medical specialty. Community acquired infections (38.7%) and surgical antibiotic prophylaxis (22.5%) were the most common indications. Surgical antibiotic prophylaxis was used or scheduled to be used for more than a day in all the cases. Metronidazole (30.5%), ciprofloxacin (17.1%), ceftriaxone (16.8%), amoxicillin-clavulanate (12.5%) and gentamicin (11.8%) were the most commonly prescribed antibiotics. Overall, broad spectrum antibiotics represented one-third of all the prescriptions. The change of initial antibiotic prescription was reported in one-third of the patients and the reasons include a switch to oral antibiotic (28.5%), escalation (4.5%) and de-escalation (3.6%). Of the 257 patients with an antibiotic prescription, 6.2% had redundant antibiotic combinations.
CONCLUSION
The prevalence of antibiotic use was high with one in three prescriptions having a broad spectrum antibiotic. Prolonged use of surgical antibiotic prophylaxis and redundant antibiotic combination were observed. Antimicrobial stewardship interventions are recommended in order to reduce the use of antibiotics and promote appropriate antibiotics prescribing.
背景
评估住院患者的抗生素使用情况是设计抗生素管理干预的首要步骤。在尼日利亚北部，有关医院抗生素使用情况的数据很少。本研究评估了三家急症护理医院住院患者的抗生素使用情况和指征。
方法
在调查当天早上 8 点之前或 8 点，使用欧洲急症护理医院卫生保健相关感染和抗生素使用的时点调查方案，对病房中的患者进行时点调查。调查于 2019 年 4 月至 5 月进行。临床药剂师在医生和护士的协助下查阅患者的病历。
结果
总体而言，在调查当天，80.1%（257/321）的患者至少使用了一种抗生素。抗生素使用率从妇产科的 72.9%到儿科医学专业的 94.6%不等。社区获得性感染（38.7%）和外科抗生素预防（22.5%）是最常见的指征。所有病例均使用或计划使用超过一天的外科抗生素预防。甲硝唑（30.5%）、环丙沙星（17.1%）、头孢曲松（16.8%）、阿莫西林-克拉维酸（12.5%）和庆大霉素（11.8%）是最常开的抗生素。总的来说，广谱抗生素占所有处方的三分之一。三分之一的患者报告了初始抗生素处方的改变，原因包括换用口服抗生素（28.5%）、升级（4.5%）和降级（3.6%）。在 257 名有抗生素处方的患者中，有 6.2%的患者存在抗生素联合使用不当。
结论
抗生素使用率很高，三分之一的处方使用的是广谱抗生素。观察到外科抗生素预防的使用时间延长和抗生素联合使用不当。建议采取抗菌药物管理措施，以减少抗生素的使用，促进合理的抗生素处方。
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