Langford Bradley J, Wu Julie Hui-Chih, Lo Jennifer, Leung Valerie, Daneman Nick, Schwartz Kevin, Garber Gary
Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada.
Pharmacy, Unity Health Network, Toronto, Ontario, Canada.
J Assoc Med Microbiol Infect Dis Can. 2019 Nov 29;4(4):233-240. doi: 10.3138/jammi.2019-0011. eCollection 2019 Dec.
Antimicrobial use (AMU) varies widely among hospitals, suggesting a need to better monitor usage and evaluate the effectiveness of antimicrobial stewardship programs (ASPs). Our objective was to assess the feasibility of implementing an online voluntary hospital antibiotic use tracking and reporting system.
An online survey was sent to ASP clinicians representing hospitals across Ontario. Hospitals that tracked total hospital-wide inpatient antibiotic use in 2017 were asked to submit either days of therapy (DOT) or defined daily doses (DDD), along with separate inpatient days (PD), which were used as the denominator. Respondents who indicated no hospital-wide AMU tracking were asked to describe the barriers to its use. Antibiotic use was displayed on a public website for consenting hospitals.
Of 201 eligible hospitals, 66 (33%) provided AMU data representing 10,634 of 25,208 (43%) eligible inpatient beds in the province. DOT and DDD data were provided by 36 hospitals, each. Weighted average antibiotic use was highest in acute teaching hospitals (513 DOT/1,000 PD, 709 DDD/1,000 PD) and lowest in complex continuing care and rehabilitation facilities (158 DOT/1,000 PD, 159 DDD/1,000 PD). Barriers cited for providing hospital-wide AMU data include lack of time and resources to collect and evaluate AMU data and technological limitations preventing data collection.
Integrating hospital AMU tracking and reporting as part of a voluntary initiative is feasible, with relatively broad participation. Short of a legislative mandate for participation, opportunities still exist to increase representation, including provision of guidance and technical support to help hospitals track and share AMU.
各医院的抗菌药物使用情况差异很大，这表明需要更好地监测使用情况并评估抗菌药物管理计划（ASP）的有效性。我们的目标是评估实施在线自愿性医院抗生素使用跟踪和报告系统的可行性。
向代表安大略省各医院的ASP临床医生发送了一份在线调查问卷。要求那些在2017年跟踪了全院住院患者抗生素总使用情况的医院提交治疗天数（DOT）或限定日剂量（DDD），以及单独的住院天数（PD），后者用作分母。表示未进行全院抗菌药物使用跟踪的受访者被要求描述使用中的障碍。抗生素使用情况在一个公共网站上向同意参与的医院展示。
在201家符合条件的医院中，66家（33%）提供了抗菌药物使用数据，占该省25208张符合条件的住院床位中的10634张（43%）。DOT和DDD数据分别由36家医院提供。加权平均抗生素使用量在急性教学医院最高（513 DOT/1000 PD，709 DDD/1000 PD），在复杂的持续护理和康复机构最低（158 DOT/1000 PD，159 DDD/1000 PD）。提到的提供全院抗菌药物使用数据的障碍包括缺乏收集和评估抗菌药物使用数据的时间和资源，以及妨碍数据收集的技术限制。
将医院抗菌药物使用跟踪和报告作为一项自愿举措的一部分是可行的，参与度相对较高。在缺乏参与的立法要求的情况下，仍有机会增加参与度，包括提供指导和技术支持，以帮助医院跟踪和分享抗菌药物使用情况。
