Chowdhury Sushmita Sana, Sastry Apurba Sankar, Sureshkumar Sathasivam, Cherian Anusha, Sistla Sujatha, Rajashekar Deepashree
Department of Microbiology, JIPMER, Dhanvantari Nagar; Department of Microbiology, JIPMER, Karaikal, Puducherry, India.
Department of Microbiology, JIPMER, Dhanvantari Nagar, Puducherry, India.
Indian J Med Microbiol. 2020 Jul-Dec;38(3 & 4):362-370. doi: 10.4103/ijmm.IJMM_20_326.
Antimicrobial resistance (AMR) presents a significant threat to human health. The root cause for this global problem is irrational antimicrobial usage. Antimicrobial stewardship (AMS) emphasises on the appropriate use of antibiotics and ensures strict implementation of antimicrobial policy guidelines. This study was conducted to evaluate the impact of auditing of AMS programme on regulating the antimicrobial policy adherence and antimicrobial usage in hospital intensive care units.
This was a prospective interventional study. It consisted of pre-implementation and implementation phases 6 months each. Two hundred and eighty patients were enrolled. Details of antibiotic consumption, surgical prophylaxis, culture/sensitivity patterns, de-escalation rates, etc., were collected in both phases. The implementation phase, in addition, included stewardship audit rounds.
In pre-implementation phase and implementation phases: policy adherence rates were 23.7% and 41.8%, respectively, de-escalation rates were 22.73% and 43.48%, respectively. Cultures were sent before the initiation of antimicrobials in 36.73% cases during the pre-implementation phase, which improved to 60.41% during the implementation phase. Defined daily dose (DDD) for the antibiotics was 98.66 DDD 100BD during the pre-implementation phase, which reduced to 91.62 DDD 100BD in the implementation phase. Total days of therapy (DOT) in the pre-implementation phase were 561 DOT1000BD, which reduced to 463 DOT1000BD during the implementation phase.
Implementation of continuous monitoring of the AMS programme, therefore, has a definite role in reducing the antimicrobial consumption and improving the compliance to the policy guidelines. A more robust study for a prolonged period is, however, necessary to have a better analysis of the outcome.
抗菌药物耐药性（AMR）对人类健康构成重大威胁。这一全球性问题的根本原因是抗菌药物的不合理使用。抗菌药物管理（AMS）强调抗生素的合理使用，并确保严格执行抗菌药物政策指南。本研究旨在评估AMS计划审核对规范医院重症监护病房抗菌药物政策依从性和抗菌药物使用的影响。
这是一项前瞻性干预研究。它包括各为期6个月的实施前阶段和实施阶段。共纳入280例患者。在两个阶段均收集了抗生素使用、手术预防、培养/药敏模式、降阶梯率等详细信息。此外，实施阶段还包括管理审核环节。
在实施前阶段和实施阶段：政策依从率分别为23.7%和41.8%，降阶梯率分别为22.73%和43.48%。在实施前阶段，36.73%的病例在开始使用抗菌药物前进行了培养，在实施阶段这一比例提高到了60.41%。实施前阶段抗生素的限定日剂量（DDD）为每100BD 98.66 DDD，在实施阶段降至每100BD 91.62 DDD。实施前阶段的总治疗天数（DOT）为每1000BD 561 DOT，在实施阶段降至每1000BD 463 DOT。
因此，实施AMS计划的持续监测在减少抗菌药物消耗和提高政策指南依从性方面具有明确作用。然而，需要进行更长期、更有力的研究，以便更好地分析结果。
