Public Health Agency of Canada, Ottawa, Ontario, Canada.
Alberta Health Services, Calgary, Alberta, Canada.
Infect Control Hosp Epidemiol. 2022 Nov;43(11):1558-1564. doi: 10.1017/ice.2021.519. Epub 2022 Mar 7.
The Canadian Nosocomial Infection Surveillance Program conducted point-prevalence surveys in acute-care hospitals in 2002, 2009, and 2017 to identify trends in antimicrobial use.
Eligible inpatients were identified from a 24-hour period in February of each survey year. Patients were eligible (1) if they were admitted for ≥48 hours or (2) if they had been admitted to the hospital within a month. Chart reviews were conducted. We calculated the prevalence of antimicrobial use as follows: patients receiving ≥1 antimicrobial during survey period per number of patients surveyed × 100%.
In each survey, 28-47 hospitals participated. In 2002, 2,460 (36.5%; 95% CI, 35.3%-37.6%) of 6,747 surveyed patients received ≥1 antimicrobial. In 2009, 3,566 (40.1%, 95% CI, 39.0%-41.1%) of 8,902 patients received ≥1 antimicrobial. In 2017, 3,936 (39.6%, 95% CI, 38.7%-40.6%) of 9,929 patients received ≥1 antimicrobial. Among patients who received ≥1 antimicrobial, penicillin use increased 36.8% between 2002 and 2017, and third-generation cephalosporin use increased from 13.9% to 18.1% ( < .0001). Between 2002 and 2017, fluoroquinolone use decreased from 25.7% to 16.3% ( < .0001) and clindamycin use decreased from 25.7% to 16.3% ( < .0001) among patients who received ≥1 antimicrobial. Aminoglycoside use decreased from 8.8% to 2.4% ( < .0001) and metronidazole use decreased from 18.1% to 9.4% ( < .0001). Carbapenem use increased from 3.9% in 2002 to 6.1% in 2009 ( < .0001) and increased by 4.8% between 2009 and 2017 ( = .60).
The prevalence of antimicrobial use increased between 2002 and 2009 and then stabilized between 2009 and 2017. These data provide important information for antimicrobial stewardship programs.
加拿大医院感染监测计划于 2002 年、2009 年和 2017 年在急症护理医院进行了时点患病率调查，以确定抗菌药物使用趋势。
从每个调查年份 2 月的 24 小时内确定符合条件的住院患者。如果患者符合以下条件，则有资格参与研究：（1）住院时间≥48 小时；或（2）在过去一个月内已住院。进行病历回顾。我们通过以下方法计算抗菌药物使用率：调查期间接受≥1 种抗菌药物治疗的患者人数/接受调查的患者人数×100%。
在每个调查中，有 28-47 家医院参与。2002 年，在 6747 名接受调查的患者中，有 2460 名（36.5%，95%CI，35.3%-37.6%）接受了至少一种抗菌药物。2009 年，在 8902 名患者中，有 3566 名（40.1%，95%CI，39.0%-41.1%）接受了至少一种抗菌药物。2017 年，在 9929 名患者中，有 3936 名（39.6%，95%CI，38.7%-40.6%）接受了至少一种抗菌药物。在接受至少一种抗菌药物治疗的患者中，青霉素的使用从 2002 年到 2017 年增加了 36.8%，第三代头孢菌素的使用从 13.9%增加到 18.1%（<0.0001）。在接受至少一种抗菌药物治疗的患者中，氟喹诺酮类药物的使用从 2002 年的 25.7%下降到 2017 年的 16.3%（<0.0001），克林霉素的使用从 25.7%下降到 16.3%（<0.0001）。氨基糖苷类药物的使用从 8.8%下降到 2.4%（<0.0001），甲硝唑的使用从 18.1%下降到 9.4%（<0.0001）。碳青霉烯类药物的使用从 2002 年的 3.9%增加到 2009 年的 6.1%（<0.0001），并在 2009 年至 2017 年间增加了 4.8%（=0.60）。
2002 年至 2009 年间，抗菌药物使用率增加，然后在 2009 年至 2017 年间稳定下来。这些数据为抗菌药物管理计划提供了重要信息。
