Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
Division of Infectious Diseases and Infection Control, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
BMC Infect Dis. 2021 Feb 27;21(1):234. doi: 10.1186/s12879-021-05921-2.
The goals of the National Action Plan on Antimicrobial Resistance (AMR) of Japan include "implementing appropriate infection prevention and control" and "appropriate use of antimicrobials," which are relevant to healthcare facilities. Specifically, linking efforts between existing infection control teams and antimicrobial stewardship programs was suggested to be important. Previous studies reported that human resources, such as full-time equivalents of infection control practitioners, were related to improvements in antimicrobial stewardship.
We posted questionnaires to all teaching hospitals (n = 1017) regarding hospital countermeasures against AMR and infections. To evaluate changes over time, surveys were conducted twice (1st survey: Nov 2016, 2nd survey: Feb 2018). A latent transition analysis (LTA) was performed to identify latent statuses, which refer to underlying subgroups of hospitals, and effects of the number of members in infection control teams per bed on being in the better statuses.
The number of valid responses was 678 (response rate, 66.7%) for the 1st survey and 559 (55.0%) for the 2nd survey. More than 99% of participating hospitals had infection control teams, with differences in activity among hospitals. Roughly 70% had their own intervention criteria for antibiotics therapies, whereas only about 60 and 50% had criteria established for the use of anti-methicillin-resistant Staphylococcus aureus antibiotics and broad-spectrum antibiotics, respectively. Only 50 and 40% of hospitals conducted surveillance of catheter-associated urinary tract infections and ventilator-associated pneumonia, respectively. Less than 50% of hospitals used maximal barrier precautions for central line catheter insertion. The LTA identified five latent statuses. The membership probability of the most favorable status in the 2nd study period was slightly increased from the 1st study period (23.6 to 25.3%). However, the increase in the least favorable status was higher (26.3 to 31.8%). Results of the LTA did not support a relationship between increasing the number of infection control practitioners per bed, which is reportedly related to improvements in antimicrobial stewardship, and being in more favorable latent statuses.
Our results suggest the need for more comprehensive antimicrobial stewardship programs and increased surveillance activities for healthcare-associated infections to improve antimicrobial stewardship and infection control in hospitals.
日本国家抗菌素耐药行动计划的目标包括“实施适当的感染预防和控制”和“抗菌药物的合理使用”，这与医疗机构有关。具体而言，建议将现有感染控制团队与抗菌药物管理计划的工作联系起来。先前的研究报告指出，感染控制从业人员等人力资源与抗菌药物管理的改善有关。
我们向所有教学医院（n=1017）发布了关于抗菌素耐药和感染的医院对策的调查问卷。为了评估随时间的变化，进行了两次调查（第 1 次调查：2016 年 11 月，第 2 次调查：2018 年 2 月）。进行潜在转变分析（LTA）以确定潜在状态，这是指医院的潜在亚组，以及感染控制团队每个床位成员数量对处于更好状态的影响。
第 1 次调查的有效回复数为 678（回复率为 66.7%），第 2 次调查的有效回复数为 559（55.0%）。超过 99%的参与医院都有感染控制团队，但医院之间的活动存在差异。大约 70%的医院有自己的抗生素治疗干预标准，而只有约 60%和 50%的医院分别制定了耐甲氧西林金黄色葡萄球菌抗生素和广谱抗生素的使用标准。只有 50%和 40%的医院对导管相关尿路感染和呼吸机相关性肺炎进行了监测。不到 50%的医院在插入中央导管时使用最大的屏障预防措施。LTA 确定了五个潜在状态。在第 2 研究期间，最有利状态的成员概率从第 1 研究期间略有增加（23.6%至 25.3%）。然而，最不利状态的增加更高（26.3%至 31.8%）。LTA 的结果不支持感染控制从业人员人数的增加与抗菌药物管理的改善相关，也不支持处于更有利的潜在状态。
我们的结果表明，需要更全面的抗菌药物管理计划和增加对医疗保健相关感染的监测活动，以改善医院的抗菌药物管理和感染控制。
