Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
Infectious Diseases, Department of Internal Medicine I, Tübingen University Hospital, Tübingen, Germany.
J Antimicrob Chemother. 2020 Dec 6;75(Suppl 2):ii33-ii41. doi: 10.1093/jac/dkaa427.
In long-term care facilities (LTCFs) residents often receive inappropriate antibiotic treatment and infection prevention and control practices are frequently inadequate, thus favouring acquisition of MDR organisms. There is increasing evidence in the literature describing antimicrobial stewardship (AMS) activities in LTCFs, but practical guidance on how surveillance data should be linked with AMS activities in this setting is lacking. To bridge this gap, the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks joined their efforts to provide practical guidance for linking surveillance data with AMS activities.
Considering the three main topics [AMS leadership and accountability, antimicrobial usage (AMU) and AMS, and antimicrobial resistance (AMR) and AMS], a literature review was performed and a list of target actions was developed. Consensus on target actions was reached through a RAND-modified Delphi process involving 40 experts from 18 countries and different professional backgrounds adopting a One Health approach.
From the 25 documents identified, 25 target actions were retrieved and proposed for expert evaluation. The consensus process produced a practical checklist including 23 target actions, differentiating between essential and desirable targets according to clinical relevance and feasibility. Flexible proposals for AMS team composition and leadership were provided, with a strong emphasis on the need for well-defined and adequately supported roles and responsibilities. Specific antimicrobial classes, AMU metrics, pathogens and resistance patterns to be monitored are addressed. Effective reporting strategies are described.
The proposed checklist represents a practical tool to support local AMS teams across a wide range of care delivery organization and availability of resources.
在长期护理机构（LTCFs）中，居民经常接受不适当的抗生素治疗，感染预防和控制措施往往不足，因此有利于获得耐多药生物体。文献中有越来越多的证据描述了长期护理机构中的抗菌药物管理（AMS）活动，但在这种环境下，如何将监测数据与 AMS 活动联系起来的实际指导还很缺乏。为了弥补这一空白，JPIAMR ARCH 和 COMBACTE-MAGNET EPI-Net 网络共同努力，为将监测数据与 AMS 活动联系起来提供了实际指导。
考虑到三个主要主题[AMS 领导和问责制、抗菌药物使用（AMU）和 AMS、以及抗菌药物耐药性（AMR）和 AMS]，进行了文献回顾，并制定了目标行动清单。通过一项涉及来自 18 个国家和不同专业背景的 40 名专家的 RAND 改良 Delphi 流程，对目标行动达成共识，采用了一种“One Health”方法。
从确定的 25 篇文献中，检索并提出了 25 项目标行动供专家评估。共识过程产生了一份实用清单，其中包括 23 项目标行动，根据临床相关性和可行性对基本目标和理想目标进行区分。为 AMS 团队组成和领导提供了灵活的建议，强烈强调需要明确和充分支持的角色和职责。还涉及了要监测的特定抗菌药物类别、AMU 指标、病原体和耐药模式。描述了有效的报告策略。
所提出的清单代表了一种实用工具，可以支持广泛的护理提供组织和资源可用性范围内的本地 AMS 团队。
