印度中部两家私立医院骨科住院部抗生素处方的趋势和模式：一项为期10年的观察性研究。
Trends and patterns of antibiotic prescribing at orthopedic inpatient departments of two private-sector hospitals in Central India: A 10-year observational study.
作者信息
Skender Kristina, Singh Vivek, Stalsby-Lundborg Cecilia, Sharma Megha
机构信息
Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden.
Department of Orthopedic, Ruxmaniben Deepchand Medical College, Ujjain, India.
出版信息
PLoS One. 2021 Jan 27;16(1):e0245902. doi: 10.1371/journal.pone.0245902. eCollection 2021.
BACKGROUND
Frequent antibiotic prescribing in departments with high infection risk like orthopedics prominently contributes to the global increase of antibiotic resistance. However, few studies present antibiotic prescribing patterns and trends among orthopedic inpatients.
AIM
To compare and present the patterns and trends of antibiotic prescription over 10 years for orthopedic inpatients in a teaching (TH) and a non-teaching hospital (NTH) in Central India.
METHODS
Data from orthopedic inpatients (TH-6446; NTH-4397) were collected using a prospective cross-sectional study design. Patterns were compared based on the indications and corresponding antibiotic treatments, mean Defined Daily Doses (DDD)/1000 patient-days, adherence to the National List of Essential Medicines India (NLEMI) and the World Health Organization Model List of Essential Medicines (WHOMLEM). Antibiotic prescriptions were analyzed separately for the operated and the non-operated inpatients. Linear regression was used to analyze the time trends of antibiotic prescribing; in total through DDD/1000 patient-days and by antibiotic groups.
RESULTS
Third generation cephalosporins were the most prescribed antibiotic class (TH-39%; NTH-65%) and fractures were the most common indications (TH-48%; NTH-48%). Majority of the operated inpatients (TH-99%; NTH-97%) were prescribed pre-operative prophylactic antibiotics. The non-operated inpatients were also prescribed antibiotics (TH-40%; NTH-75%), although few of them had infectious diagnoses (TH-8%; NTH-14%). Adherence to the NLEMI was lower (TH-31%; NTH-34%) than adherence to the WHOMLEM (TH-65%; NTH-62%) in both hospitals. Mean DDD/1000 patient-days was 16 times higher in the TH (2658) compared to the NTH (162). Total antibiotic prescribing increased over 10 years (TH-β = 3.23; NTH-β = 1.02).
CONCLUSION
Substantial number of inpatients were prescribed antibiotics without clear infectious indications. Adherence to the NLEMI and the WHOMLEM was low in both hospitals. Antibiotic use increased in both hospitals over 10 years and was higher in the TH than in the NTH. The need for developing and implementing local antibiotic prescribing guidelines is emphasized.
背景
在骨科等高感染风险科室频繁开具抗生素处方是导致全球抗生素耐药性增加的一个重要因素。然而，很少有研究阐述骨科住院患者的抗生素处方模式及趋势。
目的
比较并呈现印度中部一家教学医院（TH）和一家非教学医院（NTH）中骨科住院患者10年间的抗生素处方模式及趋势。
方法
采用前瞻性横断面研究设计收集骨科住院患者的数据（TH-6446例；NTH-4397例）。根据适应证及相应的抗生素治疗、平均限定日剂量（DDD）/1000患者日、对《印度基本药物目录》（NLEMI）和《世界卫生组织基本药物示范目录》（WHOMLEM）的依从性对模式进行比较。对接受手术和未接受手术的住院患者的抗生素处方分别进行分析。采用线性回归分析抗生素处方的时间趋势；总体上通过DDD/1000患者日以及按抗生素类别进行分析。
结果
第三代头孢菌素是处方量最多的抗生素类别（TH-39%；NTH-65%），骨折是最常见的适应证（TH-48%；NTH-48%）。大多数接受手术的住院患者（TH-99%；NTH-97%）都开具了术前预防性抗生素。未接受手术的住院患者也开具了抗生素（TH-40%；NTH-75%），尽管其中很少有人有感染性诊断（TH-8%；NTH-14%）。两家医院对NLEMI的依从性（TH-31%；NTH-34%）均低于对WHOMLEM的依从性（TH-65%；NTH-62%）。TH的平均DDD/1000患者日（2658）比NTH（162）高16倍。10年间抗生素处方总量有所增加（TH-β = 3.23；NTH-β = 1.02）。
结论
相当数量的住院患者在无明确感染指征的情况下被开具了抗生素。两家医院对NLEMI和WHOMLEM的依从性均较低。两家医院的抗生素使用在10年间均有所增加，且TH高于NTH。强调了制定和实施当地抗生素处方指南的必要性。
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