Department of Health Sciences, Helsana Group, Zurich, Switzerland.
Swiss Centre for Antibiotic Resistance (ANRESIS), Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
Euro Surveill. 2024 Sep;29(37). doi: 10.2807/1560-7917.ES.2024.29.37.2300734.
BackgroundIn Europe and other high-income countries, antibiotics are mainly prescribed in the outpatient setting, which consists of primary, specialist and hospital-affiliated outpatient care. Established surveillance platforms report antimicrobial consumption (AMC) on aggregated levels and the contribution of the different prescriber groups is unknown.AimTo determine the contribution of different prescribers to the overall outpatient AMC in Switzerland.MethodsWe conducted a retrospective observational study using claims data from one large Swiss health insurance company, covering the period from 2015 to 2022. We analysed antibiotic prescriptions (ATC code J01) prescribed in the Swiss outpatient setting. Results were reported as defined daily doses per 1,000 inhabitants per day (DID) and weighted according to the total population of Switzerland based on census data.ResultsWe analysed 3,663,590 antibiotic prescriptions from 49 prescriber groups. Overall, AMC ranged from 9.12 DID (2015) to 7.99 DID (2022). General internal medicine (40.1% of all prescribed DID in 2022), hospital-affiliated outpatient care (20.6%), group practices (17.3%), paediatrics (5.4%) and gynaecology (3.7%) were the largest prescriber groups. Primary care accounted for two-thirds of the prescribed DID. Quantity and type of antibiotics prescribed varied between the prescriber groups. Broad-spectrum penicillins, tetracyclines and macrolides were the most prescribed antibiotic classes.ConclusionPrimary care contributed considerably less to AMC than anticipated, and hospital-affiliated outpatient care emerged as an important prescriber. Surveillance at the prescriber level enables the identification of prescribing patterns within all prescriber groups, offering unprecedented visibility and allowing a more targeted antibiotic stewardship according to prescriber groups.
背景
在欧洲和其他高收入国家，抗生素主要在门诊环境下开具，包括初级保健、专科和医院附属的门诊护理。已建立的监测平台报告汇总水平的抗菌药物消耗 (AMC)，但不同开具者群体的贡献尚不清楚。
目的
确定瑞士不同开具者对整体门诊 AMC 的贡献。
方法
我们使用一家大型瑞士健康保险公司的索赔数据进行了回顾性观察研究，涵盖 2015 年至 2022 年期间。我们分析了在瑞士门诊环境下开具的抗生素处方（ATC 代码 J01）。结果以每千名居民每天定义日剂量 (DID) 报告，并根据人口普查数据按瑞士总人口进行加权。
结果
我们分析了来自 49 个开具者群体的 3,663,590 张抗生素处方。总体而言，AMC 范围从 2015 年的 9.12 DID 到 2022 年的 7.99 DID。普通内科（2022 年所有开具 DID 的 40.1%）、医院附属门诊护理（20.6%）、集团诊所（17.3%）、儿科（5.4%）和妇科（3.7%）是最大的开具者群体。初级保健占开具 DID 的三分之二。开具者群体之间开具的抗生素数量和类型存在差异。广谱青霉素类、四环素类和大环内酯类是最常开具的抗生素类别。
结论
初级保健对 AMC 的贡献远低于预期，而医院附属门诊护理成为一个重要的开具者。在开具者层面进行监测可以识别所有开具者群体中的开具模式，提供前所未有的可见性，并根据开具者群体进行更有针对性的抗生素管理。
