Médecins Sans Frontières, Operational Centre Amsterdam (OCA), Amsterdam, The Netherlands.
Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden.
Antimicrob Resist Infect Control. 2024 Aug 15;13(1):89. doi: 10.1186/s13756-024-01449-7.
Antimicrobial resistance is of great global public health concern. In order to address the paucity of antibiotic consumption data and antimicrobial resistance surveillance systems in hospitals in humanitarian settings, we estimated antibiotic consumption in six hospitals with the aim of developing recommendations for improvements in antimicrobial stewardship programs.
Six hospitals supported by Médecins sans Frontières were included in the study: Boost-Afghanistan, Kutupalong-Bangladesh, Baraka and Mweso-Democratic Republic of Congo, Kule-Ethiopia, and Bentiu-South Sudan. Data for 36,984 inpatients and antibiotic consumption data were collected from 2018 to 2020. Antibiotics were categorized per World Health Organization Access Watch Reserve classification. Total antibiotic consumption was measured by Defined Daily Doses (DDDs)/1000 bed-days.
Average antibiotic consumption in all hospitals was 2745 DDDs/1000 bed-days. Boost hospital had the highest antibiotic consumption (4157 DDDs/1000 bed-days) and Bentiu the lowest (1598 DDDs/1000 bed-days). In all hospitals, Access antibiotics were mostly used (69.7%), followed by Watch antibiotics (30.1%). The most consumed antibiotics were amoxicillin (23.5%), amoxicillin and clavulanic acid (14%), and metronidazole (13.2%). Across all projects, mean annual antibiotic consumption reduced by 22.3% during the study period, mainly driven by the reduction in Boost hospital in Afghanistan.
This was the first study to assess antibiotic consumption by DDD metric in hospitals in humanitarian settings. Antibiotic consumption in project hospitals was higher than those reported from non-humanitarian settings. Routine systematic antibiotic consumption monitoring systems should be implemented in hospitals, accompanied by prescribing audits and point-prevalence surveys, to inform about the volume and appropriateness of antibiotic use and to support antimicrobial stewardship efforts in humanitarian settings.
抗菌药物耐药性是全球公共卫生面临的重大问题。为了填补人道主义环境下医院抗生素使用数据和抗菌药物耐药性监测系统的空白，我们评估了六家无国界医生组织支持的医院的抗生素使用情况，目的是为改善抗菌药物管理计划提出建议。
本研究纳入了六家无国界医生组织支持的医院：阿富汗的 Boost 医院、孟加拉国的 Kutupalong 医院、刚果民主共和国的 Baraka 和 Mweso 医院、埃塞俄比亚的 Kule 医院和南苏丹的 Bentiu 医院。2018 年至 2020 年期间收集了 36984 名住院患者的数据和抗生素使用数据。根据世界卫生组织获取观察储备分类法对抗生素进行分类。采用限定日剂量（DDD）/1000 床日来衡量总抗生素使用量。
所有医院的平均抗生素使用量为 2745 DDD/1000 床日。Boost 医院的抗生素使用量最高（4157 DDD/1000 床日），而 Bentiu 医院的最低（1598 DDD/1000 床日）。在所有医院中，使用最多的是 Access 类抗生素（69.7%），其次是 Watch 类抗生素（30.1%）。使用最多的抗生素是阿莫西林（23.5%）、阿莫西林克拉维酸（14%）和甲硝唑（13.2%）。在整个研究期间，所有项目的平均年度抗生素使用量减少了 22.3%，主要是由于阿富汗的 Boost 医院的减少。
这是首次在人道主义环境下的医院中使用 DDD 衡量抗生素使用量的研究。项目医院的抗生素使用量高于非人道主义环境下的报告。应在医院中实施常规系统的抗生素使用监测系统，同时进行处方审核和患病率调查，以了解抗生素使用的数量和适当性，并支持人道主义环境下的抗菌药物管理工作。
