Funiciello Elisa, Lorenzetti Giulia, Cook Aislinn, Goelen Jan, Moore Catrin E, Campbell Stephen M, Godman Brian, Tong Deborah, Huttner Benedikt, Chuki Pem, Sharland Michael
Centre for Neonatal and Paediatric Infection, St. George's University of London, London SW17 0RE, UK.
Health Economics Research Centre, Nuffield, Department of Population Health, University of Oxford, Oxford OX1 2JD, UK.
J Antimicrob Chemother. 2024 Dec 2;79(12):3063-3077. doi: 10.1093/jac/dkae370.
Quality indicators (QIs) are widely used tools for antibiotic stewardship programmes. The Access, Watch, Reserve (AWaRe) system has been developed by the WHO to classify antibiotics based on their spectrum of activity and potential selection of antibiotic resistance. This review aimed to identify existing indicators for optimal antibiotic use to inform the development of future AWaRe QIs.
A literature search was performed in PubMed. We included articles describing QIs for hospital and primary healthcare antibiotic use. We extracted information about (i) the type of infection; (ii) setting; (iii) target for quality assessment; and (iv) methodology used for the development. We then identified the indicators that reflected the guidance provided in the AWaRe system.
A total of 773 indicators for antibiotic use were identified. The management of health services and/or workers, the consumption of antibiotics, and antibiotic prescribing/dispensing were the principal targets for quality assessment. There was a similar distribution of indicators across primary and secondary care. For infection-specific indicators, about 50% focused on respiratory tract infections. Only a few QIs included information on review treatment or microbiological investigations. Although only 8 (1%) indicators directly cited the AWaRe system in the wording of the indicators, 445 (57.6%) indicators reflected the guidance provided in the AWaRe book.
A high number of indicators for appropriate antibiotic use have been developed. However, few are currently based directly on the WHO AWaRe system. There is a clear need to develop globally applicable AWaRe based indicators that can be integrated into antibiotic stewardship programmes.
质量指标（QIs）是抗生素管理计划中广泛使用的工具。世界卫生组织（WHO）开发了“使用、观察、储备”（AWaRe）系统，根据抗生素的活性谱和抗生素耐药性的潜在选择对其进行分类。本综述旨在确定现有的优化抗生素使用的指标，以为未来AWaRe质量指标的制定提供参考。
在PubMed上进行文献检索。我们纳入了描述医院和初级医疗保健中抗生素使用质量指标的文章。我们提取了有关以下方面的信息：（i）感染类型；（ii）环境；（iii）质量评估目标；以及（iv）用于制定的方法。然后，我们确定了反映AWaRe系统中提供的指导的指标。
共确定了773项抗生素使用指标。卫生服务和/或工作人员的管理、抗生素的消耗以及抗生素的处方/配药是质量评估的主要目标。初级和二级保健中的指标分布相似。对于特定感染指标，约50%集中于呼吸道感染。只有少数质量指标包括了有关复查治疗或微生物学调查的信息。尽管只有8项（1%）指标在指标措辞中直接引用了AWaRe系统，但445项（57.6%）指标反映了AWaRe手册中提供的指导。
已经制定了大量关于合理使用抗生素的指标。然而，目前很少直接基于世界卫生组织的AWaRe系统。显然需要制定可全球应用的基于AWaRe的指标，以便能够纳入抗生素管理计划。
