Heudorf Ursel, Berres Marlene, Schmehl Cleo, Steul Katrin
MDRO Network Rhine-Main, Frankfurt am Main, Germany.
GMS Hyg Infect Control. 2020 Nov 27;15:Doc30. doi: 10.3205/dgkh000365. eCollection 2020.
Multidrug-resistant pathogens are a major health problem in many countries. In Germany, in accordance with the German Antibiotic Resistance Strategy (DART), the surveillance of antibiotic consumption in acute care hospitals and rehabilitation facilities was made mandatory by the Infection Protection Act in 2011 and 2017. Whereas comparable reference data for acute care hospitals are available, such data is lacking for rehabilitation facilities. Therefore, the Rhine-Main network on MDRO (Multi Drug Resistant Organisms) has offered to evaluate the antibiotic consumption of the network's rehabilitation facilities. Antimicrobial consumption (if possible already given as daily defined doses, DDD) and patient days from 2016-2018 were requested. By October 31, 2019, nine clinics, including a facility for early neurological rehabilitation, reported their consumption of antibiotics (mostly already as DDD) and patient days from 2016-2018. The information from the clinics was entered in an Excel table and the DDD calculated if necessary. In order to compare the facilities, the DDD/100 patient days (pd) were calculated for the individual active substances. Antibiotic consumption in general rehabilitation facilities decreased slightly from 4.8 DDD/100 pd to 4.4 DDD/100 pd from 2016 to 2018. In early neurological rehabilitation, antibiotic consumption increased from 10.2 DDD/100 pd to 13.1 DDD/100 pd in the same period. Among the most commonly used antibiotics, cefuroxime came first, followed by ciprofloxacin and amoxicillin in third place. To our knowledge, this is the first antimicrobial consumption data from rehabilitation facilities in Germany. Antibiotic consumption in general rehabilitation facilities is less than 10% of the consumption in normal/regular wards of acute care clinics, and the consumption in neurological early rehabilitation was approximately 10% of the consumption in intensive care wards within acute care clinics. Reserve or broad-spectrum antibiotics were rarely or not used at all in the rehabilitation facilities. Despite this overall positive situation, antibiotic stewardship should also be introduced in rehabilitation facilities, possibly with the support of the regional MDRO networks.
多重耐药病原体在许多国家都是一个重大的健康问题。在德国，根据《德国抗生素耐药性战略》（DART），2011年和2017年的《感染保护法》规定，对急症医院和康复机构的抗生素使用情况进行监测成为强制性要求。虽然有急症医院的可比参考数据，但康复机构却缺乏此类数据。因此，莱茵 - 美因耐多药微生物网络主动提出对该网络内康复机构的抗生素使用情况进行评估。要求提供2016 - 2018年的抗菌药物使用量（若可能，已按限定日剂量，即DDD给出）和患者住院天数。截至2019年10月31日，包括一家早期神经康复机构在内的9家诊所报告了其2016 - 2018年的抗生素使用量（大多已按DDD计算）和患者住院天数。诊所提供的信息被录入一个Excel表格，并在必要时计算DDD。为了比较各机构，计算了每种活性物质的DDD/100患者住院天数（pd）。普通康复机构的抗生素使用量从2016年的4.8 DDD/100 pd略微降至2018年的4.4 DDD/100 pd。在早期神经康复机构，同期抗生素使用量从10.2 DDD/100 pd增至13.1 DDD/100 pd。在最常用的抗生素中，头孢呋辛位居首位，其次是环丙沙星，阿莫西林位列第三。据我们所知，这是德国康复机构的首份抗菌药物使用数据。普通康复机构的抗生素使用量不到急症诊所普通/常规病房使用量的10%，而神经早期康复机构的使用量约为急症诊所重症监护病房使用量的10%。康复机构很少或根本不使用储备或广谱抗生素。尽管总体情况良好，但康复机构也应引入抗生素管理措施，可能需要区域耐多药微生物网络的支持。
