Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore.
Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore.
J Glob Antimicrob Resist. 2021 Mar;24:45-47. doi: 10.1016/j.jgar.2020.11.025. Epub 2020 Dec 8.
Earlier studies have reported high antibiotic use in patients hospitalised for coronavirus disease 2019 (COVID-19), resulting in concerns of increasing antimicrobial resistance with increase antibiotic use in this pandemic. Point prevalence survey (PPS) can be a quick tool to provide antibiotic prescribing information to aid antimicrobial stewardship (AMS) activities.
To describe antibiotic utilization and evaluate antibiotic appropriateness in COVID-19 patients using PPS.
Adapting Global-PPS on antimicrobial use, the survey was conducted in COVID-19 wards at 2 centres in Singapore on 22 April 2020 at 0800h. Patients on systemic antibiotics were included and evaluated for antibiotic appropriateness.
Five hundred and seventy-seven patients were screened. Thirty-six (6.2%) patients were on antibiotics and which were started at median of 7 days (inter-quartile rate (IQR), 4, 11) from symptom onset. Fifty-one antibiotics were prescribed in these patients. Overall, co-amoxiclav (26/51, 51.0%) was the most often prescribed antibiotic. Thirty-one out of 51 (60.8%) antibiotic prescriptions were appropriate. Among 20 inappropriate prescriptions, 18 (90.0%) were initiated in patients with low likelihood of bacterial infections. Antibiotic prescriptions were more appropriate when reviewed by infectious diseases physicians (13/31 [41.9%] versus 2/20 [10.0%], p=0.015), and if reasons for use were stated in notes (31/31 [100.0%] versus 16/20 [80.0%], p=0.019).
Despite low prevalence of antibiotic use among confirmed and suspected COVID-19 patients at 2 centres in Singapore, there was significant proportion of inappropriate antibiotics use where bacterial infections were unlikely. AMS teams can tailor stewardship strategies using PPS results.
早期的研究报告显示，新冠肺炎住院患者的抗生素使用率较高，因此人们担心在这场大流行中随着抗生素使用量的增加，会出现抗生素耐药性不断上升的情况。时点患病率调查（PPS）可以快速提供抗生素使用信息，有助于抗菌药物管理（AMS）活动。
通过 PPS 描述新冠肺炎患者的抗生素使用情况并评估其使用的适宜性。
我们对全球 PPS 中关于抗生素使用的部分进行了改编，并于 2020 年 4 月 22 日 08 时在新加坡的 2 家中心的新冠肺炎病房进行了这项调查。纳入正在接受全身抗生素治疗的患者，并对其进行抗生素使用适宜性评估。
共对 577 名患者进行了筛查。36 名（6.2%）患者正在使用抗生素，从出现症状到开始使用抗生素的中位时间为 7 天（四分位距（IQR），4，11）。这些患者共开具了 51 种抗生素。总体而言，复方阿莫西林（co-amoxiclav）（26/51，51.0%）是最常开具的抗生素。51 种抗生素处方中，31 种（60.8%）是适宜的。在 20 种不适当的处方中，有 18 种（90.0%）是在低细菌感染可能性的患者中开具的。如果由感染病医生进行审查（31/31 [41.9%]比 2/20 [10.0%]，p=0.015），并且在病历中注明了使用抗生素的原因（31/31 [100.0%]比 16/20 [80.0%]，p=0.019），抗生素处方的适宜性会更高。
尽管在新加坡的 2 家中心，确诊和疑似新冠肺炎患者的抗生素使用率较低，但仍有相当比例的抗生素使用是不适当的，细菌感染的可能性较低。AMS 团队可以根据 PPS 结果制定管理策略。
