2017 年美国养老院人群中的抗菌药物使用情况。
Antimicrobial Use in a Cohort of US Nursing Homes, 2017.
机构信息
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Colorado Department of Public Health and Environment, Denver.
出版信息
JAMA. 2021 Apr 6;325(13):1286-1295. doi: 10.1001/jama.2021.2900.
IMPORTANCE
Controlling antimicrobial resistance in health care is a public health priority, although data describing antimicrobial use in US nursing homes are limited.
OBJECTIVE
To measure the prevalence of antimicrobial use and describe antimicrobial classes and common indications among nursing home residents.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional, 1-day point-prevalence surveys of antimicrobial use performed between April 2017 and October 2017, last survey date October 31, 2017, and including 15 276 residents present on the survey date in 161 randomly selected nursing homes from selected counties of 10 Emerging Infections Program (EIP) states. EIP staff reviewed nursing home records to collect data on characteristics of residents and antimicrobials administered at the time of the survey. Nursing home characteristics were obtained from nursing home staff and the Nursing Home Compare website.
EXPOSURES
Residence in one of the participating nursing homes at the time of the survey.
MAIN OUTCOMES AND MEASURES
Prevalence of antimicrobial use per 100 residents, defined as the number of residents receiving antimicrobial drugs at the time of the survey divided by the total number of surveyed residents. Multivariable logistic regression modeling of antimicrobial use and percentages of drugs within various classifications.
RESULTS
Among 15 276 nursing home residents included in the study (mean [SD] age, 77.6 [13.7] years; 9475 [62%] women), complete prevalence data were available for 96.8%. The overall antimicrobial use prevalence was 8.2 per 100 residents (95% CI, 7.8-8.8). Antimicrobial use was more prevalent in residents admitted to the nursing home within 30 days before the survey date (18.8 per 100 residents; 95% CI, 17.4-20.3), with central venous catheters (62.8 per 100 residents; 95% CI, 56.9-68.3) or with indwelling urinary catheters (19.1 per 100 residents; 95% CI, 16.4-22.0). Antimicrobials were most often used to treat active infections (77% [95% CI, 74.8%-79.2%]) and primarily for urinary tract infections (28.1% [95% CI, 15.5%-30.7%]). While 18.2% (95% CI, 16.1%-20.1%) were for medical prophylaxis, most often use was for the urinary tract (40.8% [95% CI, 34.8%-47.1%]). Fluoroquinolones were the most common antimicrobial class (12.9% [95% CI, 11.3%-14.8%]), and 33.1% (95% CI, 30.7%-35.6%) of antimicrobials used were broad-spectrum antibiotics.
CONCLUSIONS AND RELEVANCE
In this cross-sectional survey of a cohort of US nursing homes in 2017, prevalence of antimicrobial use was 8.2 per 100 residents. This study provides information on the patterns of antimicrobial use among these nursing home residents.
重要性
控制医疗保健中的抗菌药物耐药性是公共卫生的优先事项，尽管有关美国疗养院中抗菌药物使用的数据有限。
目的
测量抗菌药物使用的流行率，并描述疗养院居民中抗菌药物类别和常见适应证。
设计、设置和参与者：2017 年 4 月至 2017 年 10 月进行的横断面、1 天点患病率调查，最后调查日期为 2017 年 10 月 31 日，包括在 10 个新兴传染病计划（EIP）州的选定县的 161 个随机选择的疗养院中，在调查日在场的 15276 名居民。EIP 工作人员审查疗养院记录，以收集调查时居民和管理的抗菌药物的数据。疗养院的特征从疗养院工作人员和疗养院比较网站获得。
暴露情况
在调查时居住在参与的疗养院之一。
主要结果和措施
每 100 名居民的抗菌药物使用流行率，定义为接受调查时接受抗菌药物治疗的居民人数除以接受调查的居民总数。使用多变量逻辑回归模型进行抗菌药物使用和各种分类内药物百分比的建模。
结果
在纳入研究的 15276 名疗养院居民中（平均[SD]年龄，77.6[13.7]岁；9475[62%]女性），完整的流行率数据可用于 96.8%。总体抗菌药物使用率为每 100 名居民 8.2（95%CI，7.8-8.8）。在调查日期前 30 天内入院的居民中，抗菌药物使用率更高（每 100 名居民 18.8；95%CI，17.4-20.3），有中央静脉导管（每 100 名居民 62.8；95%CI，56.9-68.3）或留置导尿管（每 100 名居民 19.1；95%CI，16.4-22.0）。抗菌药物主要用于治疗活动性感染（77%[95%CI，74.8%-79.2%]），主要用于治疗尿路感染（28.1%[95%CI，15.5%-30.7%]）。虽然 18.2%（95%CI，16.1%-20.1%）是用于医疗预防，但最常用的是用于治疗尿路感染（40.8%[95%CI，34.8%-47.1%]）。氟喹诺酮类是最常见的抗菌药物类别（12.9%[95%CI，11.3%-14.8%]），使用的 33.1%（95%CI，30.7%-35.6%）的抗菌药物为广谱抗生素。
结论和相关性
在这项 2017 年对美国疗养院队列的横断面调查中，抗菌药物使用率为每 100 名居民 8.2。本研究提供了有关这些疗养院居民中抗菌药物使用模式的信息。
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