新不伦瑞克省医院抗菌药物使用情况的现患率调查。
A Point Prevalence Survey of Antimicrobial Usage in New Brunswick Hospitals.
作者信息
Cormier Rachel, MacLaggan Tim, Landry Daniel, Harris Rachel, Flewelling Andrew
机构信息
, BSc(Pharm), was, at the time of this study, with the Pharmacy Department of The Moncton Hospital, Horizon Health Network. She is now with the Pharmacy Department of The Dr Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, New Brunswick.
, BSc(Pharm), PharmD, is with the Pharmacy Department of The Moncton Hospital, Horizon Health Network, Moncton, New Brunswick.
出版信息
Can J Hosp Pharm. 2022 Spring;75(2):79-88. doi: 10.4212/cjhp.v75i2.3093. Epub 2022 Apr 4.
BACKGROUND
Prevalence surveys are useful tools for assessing the appropriateness of antimicrobial therapy.
OBJECTIVES
The primary objective was to assess patterns of antimicrobial utilization and appropriateness in New Brunswick hospitals. The secondary objective was to assess the impact of hospital size and the presence of a penicillin allergy label on antimicrobial appropriateness.
METHODS
A point prevalence survey was conducted of inpatients taking 1 or more systemic antimicrobials during admission to hospitals in New Brunswick. A structured protocol and web-based data collection tool (National Antimicrobial Prescribing Survey) were used for this survey. Data regarding hospital size and presence of a penicillin allergy label were also collected. Antimicrobial utilization was assessed in terms of guideline compliance and appropriateness. Results were summarized descriptively. A χ analysis was performed to describe secondary outcomes.
RESULTS
Ten hospitals participated, and a total of 2200 patients were admitted at the time of the survey. The overall prevalence of antimicrobial use was 22.7% (500/2200). A total of 648 antimicrobials were ordered. The most frequently prescribed antimicrobials by class were first-generation cephalosporins (14.0%, 91/648), third-generation cephalosporins (11.3%, 73/648), and piperacillin-tazobactam (10.2%, 66/648). The most common indications for antimicrobial therapy were respiratory tract infections (27.3%, 177/648), urinary tract infections (12.2%, 79/648), and intra-abdominal infections (11.4%, 74/648). Compliance with local or regional treatment guidelines, where applicable, was 66.2% (188/284). Provincially, 68.1% (441/648) of the antimicrobial orders were deemed appropriate. Larger centres had substantially higher rates of appropriateness ( < 0.001). The presence of a penicillin allergy label had no impact on appropriateness ( = 0.21).
CONCLUSIONS
Several opportunities for targeted interventions were identified to improve antimicrobial prescribing, including decreasing the use of broad-spectrum antimicrobials, increasing guideline compliance, and ensuring documentation of antimicrobial duration by prescribers.
背景
患病率调查是评估抗菌治疗适宜性的有用工具。
目的
主要目的是评估新不伦瑞克省医院抗菌药物使用模式及适宜性。次要目的是评估医院规模及青霉素过敏标识对抗菌药物适宜性的影响。
方法
对新不伦瑞克省医院住院期间使用1种或更多种全身用抗菌药物的患者进行现患率调查。本次调查使用结构化方案和基于网络的数据收集工具（国家抗菌药物处方调查）。还收集了有关医院规模和青霉素过敏标识的数据。从指南依从性和适宜性方面评估抗菌药物使用情况。结果进行描述性总结。进行χ分析以描述次要结果。
结果
10家医院参与，调查时共收治2200例患者。抗菌药物使用的总体患病率为22.7%（500/2200）。共开出648份抗菌药物医嘱。按类别最常开具的抗菌药物是第一代头孢菌素（14.0%，91/648）、第三代头孢菌素（11.3%，73/648）和哌拉西林-他唑巴坦（10.2%，66/648）。抗菌治疗最常见的适应证是呼吸道感染（27.3%，177/648）、尿路感染（12.2%，79/648）和腹腔内感染（11.4%，74/648）。适用时，符合当地或区域治疗指南的比例为66.2%（188/284）。在全省范围内，68.1%（441/648）的抗菌药物医嘱被认为是适宜的。规模较大的中心适宜率显著更高（<0.001）。青霉素过敏标识的存在对适宜性没有影响（=0.21）。
结论
确定了几个有针对性干预的机会以改善抗菌药物处方，包括减少广谱抗菌药物的使用、提高指南依从性以及确保处方者记录抗菌药物使用疗程。
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