Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine, University Clinics, Cologne, Germany.
Interdisciplinary Antibiotic Stewardship Team, LMU Klinikum, Munich, Germany.
Infection. 2023 Jun;51(3):567-581. doi: 10.1007/s15010-023-02005-y. Epub 2023 Feb 25.
Antimicrobial resistance poses a major threat to human health globally and antibiotic overuse is a main driver of resistance. Antimicrobial stewardship (AMS) was developed to improve the rationale use of antibiotics. The Choosing Wisely campaign was initiated to ameliorate medical practice through avoidance of unnecessary diagnostic and therapeutic procedures. Our objective was to give an overview on the Choosing Wisely recommendations related to AMS practices from a selection of different countries in order to define future needs.
We evaluated the seven countries already analyzed for Choosing Wisely recommendations related to topics of infectious medicine before. Finally, we included five of the former countries (Australia/New Zealand, Canada, Italy, Switzerland, and USA) and Germany with easily accessible recommendations and selected those related to six categories of AMS as following: diagnostics, indication, choice of antiinfective drugs, dosing, application and duration of therapy.
In total, 213 recommendations could be extracted related to AMS for the six countries and were matched to the chosen categories. Interestingly, no recommendations were found for the category "dosing." Topics related to indication and diagnostics were most frequently found with 85 and 78 recommendations, respectively. Perioperative prophylaxis was a frequently addressed issue - both related to application, indication and duration. Avoiding antibiotic treatment of asymptomatic bacteriuria and upper respiratory tract infections were central topics of all countries.
AMS is an important strategy to fight increasing resistance and is frequently addressed by Choosing Wisely recommendations of different countries. Similar issues are considered important in the selected countries.
抗菌药物耐药性对全球人类健康构成重大威胁，而抗生素的过度使用是耐药性的主要驱动因素。抗菌药物管理（AMS）旨在改善抗生素的合理使用。明智选择运动旨在通过避免不必要的诊断和治疗程序来改善医疗实践。我们的目的是从不同国家中选择一些国家，概述明智选择与 AMS 实践相关的建议，以确定未来的需求。
我们评估了之前已经分析过的与传染病主题相关的明智选择建议的七个国家。最后，我们纳入了五个前国家（澳大利亚/新西兰、加拿大、意大利、瑞士和美国）和德国，这些国家的建议容易获取，并选择了与 AMS 的六个类别相关的建议，如下：诊断、适应证、抗感染药物选择、剂量、治疗应用和持续时间。
总共可以为这六个国家提取出 213 条与 AMS 相关的建议，并将其与所选类别进行匹配。有趣的是，没有发现与“剂量”类别相关的建议。适应证和诊断相关的主题是最常发现的，分别有 85 条和 78 条建议。围手术期预防是一个经常涉及的问题，与应用、适应证和持续时间都有关。避免无症状菌尿和上呼吸道感染的抗生素治疗是所有国家的核心主题。
AMS 是对抗日益增加的耐药性的重要策略，不同国家的明智选择建议经常涉及到这一策略。在选定的国家中，类似的问题被认为是重要的。
