Grau Santiago, Hernández Sergi, Limón Enric, Calbo Esther, Horcajada Juan P
Service of Pharmacy, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain.
VINCat Program Surveillance of healthcare related infections in Catalonia, Barcelona, Spain.
JAC Antimicrob Resist. 2020 Oct 16;2(4):dlaa079. doi: 10.1093/jacamr/dlaa079. eCollection 2020 Dec.
In 2019 the WHO fully adopted new DDD values. The objective of this study is to analyse their impact on the measurement of consumption of antibacterials in hospitals participating in the Catalan Infection Control and Antimicrobial Stewardship National Program (VINCat-PROA) in Catalonia (Spain) between 2008 and 2018.
The anatomical therapeutic chemical/DDD system was used to monitor adult hospital antibacterial consumption expressed in DDD/100 bed-days. Consumption from 2008 to 2018 was calculated using both pre- and post-update DDD values. Differences were calculated as the percentage variation in DDD/100 bed-days and analysed with Student's -test. Simple linear regressions were performed to evaluate the trends in adult antimicrobial consumption over the study period.
The overall consumption according to post-update DDD values decreased by 12.2% (<0.001) compared with the pre-update DDD values. Penicillins (-19.6.%; <0.001) and carbapenems (-19.0%; =0.023) showed the greatest reduction, followed by cephalosporins (-7.7%; =0.021) and quinolone antibacterials (-7.7%; =0.017). ICU services showed the greatest overall reduction (-13.1%; <0.001). From 2008 to 2018 there was a statistically significant decrease in consumption of penicillins and quinolone antibacterials and a statistically significant increase in cephalosporin and carbapenem consumption with both pre- and post-update DDD values. There were no variations in the ranking of consumption between the pre- and post-update DDD values.
The WHO's updates of DDDs have had a significant impact on the measurement of antibacterial consumption. In our region, they have corrected an overestimation of penicillin and carbapenem consumption amounting to 19%. It is essential to bear these findings in mind for an accurate assessment of temporal trends and benchmarking.
2019年世界卫生组织（WHO）全面采用了新的限定日剂量（DDD）值。本研究的目的是分析这些值对2008年至2018年期间参与西班牙加泰罗尼亚感染控制与抗菌药物管理国家计划（VINCat-PROA）的加泰罗尼亚医院抗菌药物使用量测量的影响。
采用解剖学治疗学化学/DDD系统，以DDD/100床日为单位监测成人医院抗菌药物使用量。使用更新前和更新后的DDD值计算2008年至2018年的使用量。差异计算为DDD/100床日的百分比变化，并采用Student's t检验进行分析。进行简单线性回归以评估研究期间成人抗菌药物使用量的趋势。
与更新前的DDD值相比，更新后的DDD值显示总体使用量下降了12.2%（P<0.001）。青霉素（-19.6%；P<0.001）和碳青霉烯类（-19.0%；P=0.023）下降幅度最大，其次是头孢菌素（-7.7%；P=0.021）和喹诺酮类抗菌药物（-7.7%；P=0.017）。重症监护病房（ICU）服务总体下降幅度最大（-13.1%；P<0.001）。2008年至2018年，使用更新前和更新后的DDD值时，青霉素和喹诺酮类抗菌药物的使用量均有统计学显著下降，头孢菌素和碳青霉烯类的使用量有统计学显著增加。更新前和更新后的DDD值之间的使用量排名没有变化。
WHO对DDD的更新对抗菌药物使用量的测量产生了重大影响。在我们地区，它们纠正了对青霉素和碳青霉烯类使用量高估达19%的情况。为了准确评估时间趋势和进行基准比较，必须牢记这些发现。
