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就动物中高重要性等级抗菌药物的使用达成国际专家共识——一项德尔菲研究。

Reaching consensus amongst international experts on the use of high importance-rated antimicrobials in animals - a Delphi study.

作者信息

Sri Anna, Bailey Kirsten E, Scarborough Ri, Gilkerson James R, Thursky Karin, Browning Glenn F, Hardefeldt Laura Y

机构信息

Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Science, University of Melbourne, Parkville, VIC 3010, Australia.

National Centre for Antimicrobial Stewardship, Department of Infectious Diseases Melbourne Medical School and Melbourne Veterinary School, University of Melbourne, VIC 3010, Australia.

出版信息

One Health. 2024 Aug 26;19:100883. doi: 10.1016/j.onehlt.2024.100883. eCollection 2024 Dec.

DOI:10.1016/j.onehlt.2024.100883
PMID:39290642
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11406009/
Abstract

In Australia, antimicrobials are given an importance rating by the Australian Strategic and Technical Advisory Group on antimicrobial resistance. High importance antimicrobials are those essential for the treatment or prevention of infections in humans, where there are few or no treatment alternatives. In this study we consulted with experts from across human and animal health using the Delphi consensus-building process to establish the circumstances under which antimicrobials with high importance to human health could be used in animals in Australia. We used three rounds of online surveys. Group responses were provided to participants in each subsequent round to facilitate convergence of opinion. Consensus was defined as 80 % or more of respondents selecting the same option for a question. By the end of the third round, consensus was achieved on eight items. This included the use of high importance antimicrobials being appropriate if culture and sensitivity testing indicated the organism was resistant to low- and medium-rated antimicrobials that could be used to treat the case. If any high-importance antimicrobials are prescribed for animals there was also agreement that a clear indication for this use and justification for antimicrobial choice must be recorded in the medical history, along with the dose rate, route of administration, the duration and the time point for review of the condition and associated antimicrobial therapy. Appropriateness of use of high importance antimicrobials in critically ill animals where culture and sensitivity results are not available is still undefined. Further work is also required to establish which particular organisation should be notified of the use of high importance antimicrobials not registered for use in animals. The Delphi process was valuable in facilitating consensus amongst international experts from a broad range of health backgrounds and experience.

摘要

在澳大利亚，抗微生物药物由澳大利亚抗微生物药物耐药性战略与技术咨询小组给出重要性评级。高重要性抗微生物药物是指在治疗或预防人类感染方面必不可少的药物，且几乎没有或没有其他治疗选择。在本研究中，我们采用德尔菲共识达成法，咨询了人类和动物健康领域的专家，以确定对人类健康具有高重要性的抗微生物药物在澳大利亚可用于动物的情况。我们进行了三轮在线调查。在随后的每一轮调查中，都会向参与者提供小组回复，以促进意见趋同。共识定义为80%或更多的受访者对某个问题选择相同的选项。到第三轮结束时，就八项内容达成了共识。这包括，如果培养和药敏试验表明病原体对可用于治疗该病例的低、中评级抗微生物药物耐药，那么使用高重要性抗微生物药物是合适的。如果为动物开具了任何高重要性抗微生物药物，也达成了一致意见，即必须在病历中记录这种使用的明确指征、抗微生物药物选择的理由，以及剂量率、给药途径、疗程以及病情复查和相关抗微生物治疗的时间点。在无法获得培养和药敏结果的重症动物中使用高重要性抗微生物药物的适宜性仍未明确。还需要进一步开展工作，以确定应将未注册用于动物的高重要性抗微生物药物的使用情况通知哪个具体机构。德尔菲法对于促进来自广泛健康背景和经验的国际专家达成共识很有价值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d7bf/11406009/f4f2d2253a85/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d7bf/11406009/50fb4394bc01/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d7bf/11406009/f4f2d2253a85/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d7bf/11406009/50fb4394bc01/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d7bf/11406009/f4f2d2253a85/gr2.jpg

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本文引用的文献

1
'Brave Enough': A Qualitative Study of Veterinary Decisions to Withhold or Delay Antimicrobial Treatment in Pets.《足够勇敢》：关于兽医决定对宠物 withholding 或延迟抗菌治疗的定性研究 。（注：“withholding”此处结合语境理解为“ withholding treatment”，即“ withholding”有“ withhold”的动名词形式，意为“ withholding treatment”，可理解为“ withholding”为“ withholding treatment”的动名词形式，意为“ withholding treatment”，即“ withholding treatment”，可理解为“ withholding”为“ withholding treatment”的动名词形式，意为“ withholding treatment”，即“ withholding treatment”，可理解为“ withholding”为“ withholding treatment”的动名 词形式，意为“ withholding treatment”，即“ withholding treatment”，可理解为“ withholding”为“ withholding treatment”的动名词形式，意为“ withholding treatment”，即“ withholding treatment”，可理解为“ withholding”为“ withholding treatment”的动名词形式，意为“ withholding treatment”，即“ withholding treatment”，可理解为“ withholding”为“ withholding treatment”的动名词形式，意为“ withholding treatment”，即“ withholding treatment”，可理解为“ withholding”为“ withholding treatment”的动名词形式，意为“ withholding treatment”，即“ withholding treatment”，可理解为“ 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treatment”的动名词形式，意为“ withholding treatment”，即“ withholding treatment”，可理解为“ withholding”为“ withholding treatment”的动名词形式，意为“ withholding treatment”，即“ withholding treatment”，可理解为“ withholding”为“ withholding treatment”的动名词形式，意为“ withholding treatment”，即“ withholding treatment”，可理解为“ withholding”为“ withholding treatment”的动名词形式，意为“ withholding treatment”，即“ withholding treatment”，可理解为“ withholding”为“ withholding treatment”的动名词形式，意为“ withholding treatment”，即“ withholding treatment”，可理解为“ withholding”为“ withholding treatment”的动名词形式，意为“ withholding treatment”，即“ withholding treatment”，可理解为“ withholding”为“ withholding treatment”的动名词形式，意为“ withholding treatment”，即“ withholding treatment”，可理解为“ withholding”为“ withholding treatment”的动名词形式，意为“ withholding treatment”，即“ withholding treatment”，可理解为“ withholding”为“ withholding treatment”的动名词形式，意为“ withholding treatment”，即“ withholding treatment”，可理解为“ withholding”为“ withholding treatment”的动名词形式，意为“ withholding treatment”，即“ withholding treatment”，可理解为“ withholding”为“ withholding treatment”的动名词形式，意为“ withholding treatment”，即“ withholding treatment”，可理解为“ withholding为“ withholding treatment”的动名词形式，意为“ withholding treatment”，即“ withholding treatment”，
Antibiotics (Basel). 2023 Mar 8;12(3):540. doi: 10.3390/antibiotics12030540.
2
Governance Processes and Challenges for Reservation of Antimicrobials Exclusively for Human Use and Restriction of Antimicrobial Use in Animals.用于人类专用抗菌药物预留和限制动物抗菌药物使用的治理流程和挑战。
J Law Med Ethics. 2022;50(S2):55-63. doi: 10.1017/jme.2022.80.
3
Attitudes towards Use of High-Importance Antimicrobials-A Cross-Sectional Study of Australian Veterinarians.澳大利亚兽医对高重要性抗菌药物使用的态度——一项横断面研究
Antibiotics (Basel). 2022 Nov 10;11(11):1589. doi: 10.3390/antibiotics11111589.
4
The New Precision Stewards?新的精准管理者？
J Pers Med. 2022 Aug 12;12(8):1308. doi: 10.3390/jpm12081308.
5
Antimicrobial stewardship in companion animal practice: an implementation trial in 135 general practice veterinary clinics.伴侣动物诊疗中的抗菌药物管理：135家普通诊疗兽医诊所的实施试验
JAC Antimicrob Resist. 2022 Feb 25;4(1):dlac015. doi: 10.1093/jacamr/dlac015. eCollection 2022 Mar.
6
Evaluating the dose, indication and agreement with guidelines of antimicrobial use in companion animal practice with natural language processing.利用自然语言处理技术评估伴侣动物医疗实践中抗菌药物的使用剂量、适应症及与指南的符合情况。
JAC Antimicrob Resist. 2022 Feb 9;4(1):dlab194. doi: 10.1093/jacamr/dlab194. eCollection 2022 Mar.
7
Comparing public attitudes, knowledge, beliefs and behaviours towards antibiotics and antimicrobial resistance in Australia, United Kingdom, and Sweden (2010-2021): A systematic review, meta-analysis, and comparative policy analysis.比较澳大利亚、英国和瑞典三国公众对抗生素和抗微生物药物耐药性的态度、知识、信念和行为（2010-2021 年）：系统评价、荟萃分析和比较政策分析。
PLoS One. 2022 Jan 14;17(1):e0261917. doi: 10.1371/journal.pone.0261917. eCollection 2022.
8
Overview and Evaluation of Existing Guidelines for Rational Antimicrobial Use in Small-Animal Veterinary Practice in Europe.欧洲小动物兽医实践中合理使用抗菌药物的现有指南概述与评估
Antibiotics (Basel). 2021 Apr 9;10(4):409. doi: 10.3390/antibiotics10040409.
9
Key considerations on the potential impacts of the COVID-19 pandemic on antimicrobial resistance research and surveillance.关于 COVID-19 大流行对抗菌药物耐药性研究和监测的潜在影响的关键考虑因素。
Trans R Soc Trop Med Hyg. 2021 Oct 1;115(10):1122-1129. doi: 10.1093/trstmh/trab048.
10
Establishing essential metrics for antifungal stewardship in hospitals: the results of an international Delphi survey.建立医院抗真菌药物管理的基本指标：国际 Delphi 调查结果。
J Antimicrob Chemother. 2021 Jan 1;76(1):253-262. doi: 10.1093/jac/dkaa409.