Hardefeldt L Y, Hur B, Richards S, Scarborough R, Browning G F, Billman-Jacobe H, Gilkerson J R, Ierardo J, Awad M, Chay R, Bailey K E
Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.
Greencross Vets Pty Ltd, Brisbane, Queensland, Australia.
JAC Antimicrob Resist. 2022 Feb 25;4(1):dlac015. doi: 10.1093/jacamr/dlac015. eCollection 2022 Mar.
Antimicrobial stewardship programmes (ASPs) have been widely implemented in medical practice to improve antimicrobial prescribing and reduce selection for multidrug-resistant pathogens.
To implement different antimicrobial stewardship intervention packages in 135 veterinary practices and assess their impact on antimicrobial prescribing.
In October 2018, general veterinary clinics were assigned to one of three levels of ASP, education only (CON), intermediate (AMS1) or intensive (AMS2). De-identified prescribing data (1 October 2016 to 31 October 2020), sourced from VetCompass Australia, were analysed and a Poisson regression model fitted to identify the effect of the interventions on the incidence rates of antimicrobial prescribing.
The overall incidence rate (IR) of antimicrobial prescribing for dogs and cats prior to the intervention was 3.7/100 consultations, which declined by 36% (2.4/100) in the implementation period, and by 50% (1.9/100) during the post-implementation period. Compared with CON, in AMS2 there was a 4% and 6% reduction in the overall IR of antimicrobial prescribing, and a 24% and 24% reduction in IR of high importance antimicrobial prescribing, attributable to the intervention in the implementation and post-implementation periods, respectively. A greater mean difference in the IR of antimicrobial prescribing was seen in high-prescribing clinics.
These AMS interventions had a positive impact in a large group of general veterinary practices, resulting in a decline in overall antimicrobial use and a shift towards use of antimicrobials rated as low importance, with the greatest impact in high-prescribing clinics.
抗菌药物管理计划（ASPs）已在医疗实践中广泛实施，以改善抗菌药物的处方开具情况，并减少对多重耐药病原体的选择。
在135家兽医诊所实施不同的抗菌药物管理干预方案，并评估其对抗菌药物处方开具的影响。
2018年10月，普通兽医诊所被分配到三个级别的抗菌药物管理计划之一，即仅教育（CON）、中级（AMS1）或强化（AMS2）。分析了来自澳大利亚兽医指南针项目的匿名处方数据（2016年10月1日至2020年10月31日），并拟合了泊松回归模型，以确定干预措施对抗菌药物处方发生率的影响。
干预前犬猫抗菌药物处方的总体发生率（IR）为3.7/100次会诊，在实施期间下降了36%（2.4/100），在实施后期间下降了50%（1.9/100）。与CON相比，在AMS2中，抗菌药物处方的总体IR分别在实施期和实施后期因干预措施而降低了4%和6%，高重要性抗菌药物处方的IR分别降低了24%和24%。在高处方率诊所中，抗菌药物处方IR的平均差异更大。
这些抗菌药物管理干预措施对一大批普通兽医诊所有积极影响，导致总体抗菌药物使用量下降，并转向使用重要性评级较低的抗菌药物，在高处方率诊所中影响最大。
