监测指标在医院抗菌药物管理中的应用。
Use of monitoring indicators in hospital management of antimicrobials.
作者信息
da Silva Ravena Melo Ribeiro, de Mendonça Simonize Cunha B, Leão Ingrid Novaes, Dos Santos Quesia Nery, Batista Alessandra Macedo, Melo Matheus Santos, Xavier Milena da Motta, Quintans Júnior Lucindo José, da Silva Wellington Barros, Lobo Iza Maria Fraga
机构信息
Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Se, Brazil.
University Hospital, Federal University of Sergipe, São Cristóvão, Se, Brazil.
出版信息
BMC Infect Dis. 2021 Aug 17;21(1):827. doi: 10.1186/s12879-021-06542-5.
BACKGROUND
According to the literature, 25% to 50% of antimicrobials prescribed in hospitals are unnecessary or inappropriate, directly impacting antimicrobial resistance. Thus, the present study aimed to evaluate the use of antimicrobials in a university hospital in Northeast Brazil, using days of therapy (DOT) and length of therapy (LOT) indicators in accordance with the latest national and international recommendations for monitoring the use of antimicrobials.
METHODS
This is an observational, prospective analytical study conducted in a teaching hospital, with 94 active beds, distributed between the intensive care unit (ICU), the surgical clinic (SUR), the medical clinic (MED), the pneumology/infectology department (PNE/INF) and pediatrics (PED). The duration of the study was from the beginning of January to the end of December 2018.
RESULTS
During the study period, a total of 11,634 patient-days were followed up and 50.4% of the patients were found to have received some antimicrobial, with a significant reduction in use of 1% per month throughout the year. Patients were receiving antimicrobial therapy for 376 days in every 1000 days of hospitalization (LOT = 376/1000pd). Overall, the 1st-generation cephalosporins and fluoroquinolones were the most used in respect of the number of prescriptions and the duration of therapy. The calculated global DOT/LOT ratio showed that each patient received an average of 1.5 antimicrobials during the hospital stay. The incidence of antimicrobial resistance, globally, for both methicillin-resistant Staphylococcus aureus (methicillin R), Carbapenem-resistant Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii (Carbapenem R), was 1 per 1000 patient-days.
CONCLUSIONS
The results obtained from the analyses revealed that half of the patients admitted to the hospital who took part in the study were exposed to the use of antimicrobials at some point during their stay. Although moderate, it is noteworthy that there was a decline in the use of antimicrobials throughout the year. The indicators used in this study were found to be very effective for gathering data on the use of antimicrobials, and assessing the results of the initiatives taken as part of the Stewardship program.
背景
根据文献，医院开具的抗菌药物中有25%至50%是不必要的或不恰当的，这直接影响了抗菌药物耐药性。因此，本研究旨在根据最新的国家和国际抗菌药物使用监测建议，使用治疗天数（DOT）和治疗时长（LOT）指标，评估巴西东北部一家大学医院的抗菌药物使用情况。
方法
这是一项在一家拥有94张病床的教学医院进行的观察性前瞻性分析研究，这些病床分布在重症监护病房（ICU）、外科诊所（SUR）、内科诊所（MED）、肺病/传染病科（PNE/INF）和儿科（PED）。研究持续时间为2018年1月初至12月底。
结果
在研究期间，共随访了11,634个患者住院日，发现50.4%的患者接受了某种抗菌药物治疗，全年使用量每月显著下降1%。每1000个住院日中，患者接受抗菌药物治疗的天数为376天（LOT = 376/1000pd）。总体而言，就处方数量和治疗时长而言，第一代头孢菌素和氟喹诺酮类药物使用最为频繁。计算得出的总体DOT/LOT比率显示，每位患者在住院期间平均接受1.5种抗菌药物治疗。耐甲氧西林金黄色葡萄球菌（耐甲氧西林R）、耐碳青霉烯类肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌（耐碳青霉烯类R）的总体抗菌药物耐药发生率为每1000个患者住院日1例。
结论
分析结果显示，参与研究的住院患者中有一半在住院期间的某个时间点接触过抗菌药物治疗。尽管降幅不大，但值得注意的是，全年抗菌药物使用量有所下降。本研究中使用的指标对于收集抗菌药物使用数据以及评估作为管理计划一部分所采取举措的结果非常有效。
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