Health PEI (German, Lutes), Charlottetown, PEI; McGill University Health Centre (Frenette, Thirion), Montréal, Que.; Faculty of Pharmacy (Caissy, Thirion), Université de Montréal, Montréal, Que.; Vancouver General Hospital (Grant), Vancouver, BC; Montreal Children's Hospital (Lefebvre), Montréal, Que.; McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Perth and Smiths Falls District Hospital (Roberts), Smiths Falls, Ont.; Fraser Health (Afra), Surrey, BC; Université de Sherbrooke (Valiquette), Sherbrooke, Que.; Hôpital Maisonneuve-Rosemont (Émond), Montréal, Que.; Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (Carrier), Trois-Rivières, Que.; Centre hospitalier de Lanaudière (Lauzon-Laurin), Joliette Saint-Charles-Borromée, Que.; McGill University (Nguyen) Montréal, Que.; Department of Microbiology and Immunology, Hôpital Charles-Le Moyne (Al-Bachari), Longueuil, Que.; Saskatchewan Health Authority (Kosar, Peermohamed), Saskatoon, Sask.; The Hospital for Sick Children (Science), Toronto, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Landry), Vitalité Health Network, Horizon Health Network (MacLaggan), Moncton, NB; Memorial University of Newfoundland (Daley, McDonald), St. John's, Nfld.; Département de Pharmacie (Ang), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Richmond Hospital (Chang), Richmond, BC; Lions Gate Hospital (Lin, Malfair), University of British Columbia, Vancouver, BC; Faculty of Pharmaceutical Sciences (Tong), University of British Columbia, Vancouver, BC; Infection Prevention and Control (Leung), Providence Health Care, Vancouver, BC; North York General Hospital (Katz), North York, Ont.; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (Pauwels, Goossens, Versporten), University of Antwerp, Antwerp, Belgium; University of Calgary and Alberta Health Services (Conly), Foothills Medical Centre, Calgary, Alta.
CMAJ Open. 2021 Dec 21;9(4):E1242-E1251. doi: 10.9778/cmajo.20200274. Print 2021 Oct-Dec.
Patient-level surveillance of antimicrobial use (AMU) in Canadian hospitals empowers the reduction of inappropriate AMU and was piloted in 2017 among 14 hospitals in Canada. We aimed to describe AMU on the basis of patient-level data in Canadian hospitals in 2018 in terms of antimicrobial prescribing prevalence and proportions, antimicrobial indications, and agent selection in medical, surgical and intensive care wards.
Canadian adult, pediatric and neonatal hospitals were invited to participate in the standardized web-based cross-sectional Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) conducted in 2018. An identified site administrator assigned all wards admitting inpatients to specific surveyors. A physician, pharmacist or nurse with infectious disease training performed the survey. The primary outcomes were point prevalence rates for AMU over the study period regarding prescriptions, indications and agent selection in medical, surgical and intensive care wards. The secondary outcomes were AMU for resistant organisms and practice appropriateness evaluated on the basis of quality indicators. Antimicrobial consumption is presented in terms of prevalence and proportions.
Forty-seven of 118 (39.8%) hospitals participated in the survey; 9 hospitals were primary care centres, 15 were secondary care centres and 23 were tertiary or specialized care centres. Of 13 272 patients included, 33.5% ( = 4447) received a total of 6525 antimicrobials. Overall, 74.1% (4832/6525) of antimicrobials were for therapeutic use, 12.6% ( = 825) were for medical prophylaxis, 8.9% ( = 578) were for surgical prophylaxis, 2.2% ( = 143) were for other use and 2.3% ( = 147) were for unidentified reasons. A diagnosis or indication was documented in the patient's file at the initiation for 87.3% ( = 5699) of antimicrobials; 62.9% ( = 4106) of antimicrobials had a stop or review date; and 72.0% ( = 4697) of prescriptions were guided by local guidelines.
Overall, three-quarters of AMU was for therapeutic use across participating hospitals. Canadian hospitals should be further incentivized to create and adapt local guidelines on the basis of recent antimicrobial resistance data.
对加拿大医院中抗菌药物使用（AMU）的患者层面监测可增强对不适当 AMU 的减少，并于 2017 年在加拿大的 14 家医院进行了试点。我们旨在根据 2018 年加拿大医院的患者层面数据，描述医疗、外科和重症监护病房的抗菌药物处方流行率和比例、抗菌药物适应证和药物选择方面的 AMU。
邀请加拿大成人、儿科和新生儿医院参加 2018 年全球抗菌药物消耗和耐药性点患病率调查（Global-PPS）的标准化网络横断面研究。指定的站点管理员将所有收治住院患者的病房分配给特定的调查员。具有传染病培训的医生、药剂师或护士进行调查。主要结局指标是研究期间医疗、外科和重症监护病房中关于处方、适应证和药物选择的 AMU 点患病率率。次要结局指标是基于质量指标评估的耐药菌的 AMU 和实践适宜性。抗菌药物消耗以流行率和比例表示。
118 家医院中有 47 家（39.8%）参与了调查；9 家医院为初级保健中心，15 家为二级保健中心，23 家为三级或专科保健中心。在纳入的 13272 名患者中，33.5%（=4447）共接受了 6525 种抗菌药物治疗。总体而言，74.1%（4832/6525）的抗菌药物为治疗用途，12.6%（=825）为医学预防，8.9%（=578）为手术预防，2.2%（=143）为其他用途，2.3%（=147）为不明原因。在开始治疗时，87.3%（=5699）的抗菌药物有诊断或适应证记录在患者病历中；62.9%（=4106）的抗菌药物有停药或审查日期；72.0%（=4697）的处方由当地指南指导。
总体而言，三分之二的 AMU 是参与医院的治疗用途。应进一步激励加拿大医院根据最近的抗菌药物耐药数据制定和调整当地指南。
