Department of Global Public Health, Health Systems and Policy. Karolinska Institutet, SE-171 77, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Division of Clinical Physiology, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
BMC Infect Dis. 2020 May 13;20(1):340. doi: 10.1186/s12879-020-05059-7.
Antibiotic resistance is an emerging problem caused due to antibiotic use. In countries with high rates of infectious diseases, antibiotic resistance is a frequent cause of mortality. The aim was to analyse antibiotic prescribing practices between 2008 and 2017 in a teaching (TH) and a non-teaching (NTH) hospital, as typical hospitals of low- and middle-income countries, and to compare antibiotic prescribing for severe infectious indications for which empiric antibiotic treatment is recommended.
Data from adult patients registered at two Indian private-sector hospitals with one of the following indications: epiglottitis, pneumonia, peritonitis, pyelonephritis, cellulitis, erysipelas, septic arthritis, endocarditis, meningitis or sepsis; were included and analysed. Antibiotic prescription data was analyzed using the World Health Organization's (WHO) Anatomical Therapeutic Chemical classification system and the Defined Daily Doses. Chi-square and linear regression were used to compare the data between groups. Time series analyses were conducted using linear regression. P-values < 0.05 were considered significant.
In total, 3766 patients were included, 2504 inpatients in the NTH and 1262 in the TH, of which 92 and 89% patients, respectively, were prescribed antibiotics. Sixty-one percent of total prescriptions in the TH and 40% in the NTH comprised the access category of antibiotics (i.e. the first-choice of treatment according to the WHO). The WHO's second-choice of treatment, the watch category, comprised 29 and 40% of total prescriptions in the TH and NTH, respectively. Prescribing of fixed-dose combinations (FDCs) of antibiotics was significantly higher in the NTH (18%) than in the TH (8%, P < 0.05). Prescribing of watch antibiotics and FDCs increased significantly in both hospitals between 2008 and 2017 among patients with pneumonia, cellulitis and peritonitis (P < 0.05).
Prescribing of watch antibiotics and FDCs of antibiotics increased over time at both hospitals, indicating under prescribing of access antibiotics and more prescribing of second-choice antibiotics. The results can be used to highlight the areas of improvement in similar settings. Implementing diagnostic routines and local prescribing guidelines could improve the prescribing practices.
抗生素耐药性是由于抗生素的使用而产生的一个新出现的问题。在传染病发病率较高的国家，抗生素耐药性是导致死亡率的常见原因。本研究旨在分析一所教学医院（TH）和一所非教学医院（NTH） 2008 年至 2017 年期间的抗生素处方实践，并比较针对严重感染的抗生素处方，这些感染需要经验性抗生素治疗。
纳入了在两家印度私立医院就诊的具有以下一种或多种指征的成年患者的数据：会厌炎、肺炎、腹膜炎、肾盂肾炎、蜂窝织炎、丹毒、化脓性关节炎、心内膜炎、脑膜炎或败血症；使用世界卫生组织（WHO）解剖治疗化学分类系统和限定日剂量（DDD）对抗生素处方数据进行分析。采用卡方检验和线性回归比较组间数据。使用线性回归进行时间序列分析。P 值<0.05 被认为具有统计学意义。
共纳入 3766 例患者，NTH 有 2504 例住院患者，TH 有 1262 例，分别有 92%和 89%的患者接受了抗生素治疗。TH 和 NTH 的抗生素处方中，61%和 40%属于抗生素准入类别（即根据 WHO 作为治疗首选的药物）。WHO 的治疗第二选择，即观察类别，分别占 TH 和 NTH 总处方的 29%和 40%。NTH 抗生素固定剂量组合（FDC）的处方明显高于 TH（18%比 8%，P<0.05）。2008 年至 2017 年期间，两家医院肺炎、蜂窝织炎和腹膜炎患者的观察用抗生素和 FDC 的处方均显著增加（P<0.05）。
两家医院的观察用抗生素和 FDC 抗生素的处方随时间推移而增加，表明准入类抗生素的处方减少，第二选择的抗生素处方增加。研究结果可用于突出类似环境中需要改进的领域。实施诊断常规和当地处方指南可以改善处方实践。
