Ali Saied, Gash Sadhbh, Weir Niamh, Burns Karen, Dinesh Binu, Mcdermott Helene, Fitzpatrick Fidelma, O'Donnell Sinead, O'Connor Ciara
Department of Clinical Microbiology, Beaumont Hospital, Dublin 9, Ireland.
Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
JAC Antimicrob Resist. 2025 Aug 28;7(4):dlaf146. doi: 10.1093/jacamr/dlaf146. eCollection 2025 Aug.
To evaluate the environmental impact of prolonged IV antimicrobial courses and identify opportunities for improved antimicrobial stewardship (AMS) practices.
A retrospective cross-sectional study was conducted using AMS ward-round data from January 2023 to December 2024 at a tertiary hospital in Dublin, Ireland. Data on IV antimicrobial prescriptions, AMS recommendations for discontinuation or IV to oral switch (IVOS) and prescriber acceptance were reviewed. A life cycle assessment, informed by published literature, was used to estimate the carbon footprint associated with IV use.
Of 1929 antimicrobial prescriptions reviewed, 58% ( = 1119) were being administered IV. Among 435 IV prescriptions with AMS, recommendations to stop ( = 357) or IVOS ( = 78), 229 (52.6%) were accepted, resulting in a reduction of 106.5 kg of clinical waste and 261.2 kg carbon dioxide equivalents (CO₂e) emissions. The remaining 206 IV prescriptions (47.4%) were categorized as prolonged IV prescriptions, generating 98.8 kg of clinical waste and 245.8 kg CO₂e; averaging 0.48 kg of waste and 1.19 kg CO₂e per prescription. To contextualize, the carbon footprint of each prolonged prescription equates to driving 6.2 km, performing 10 chest X-rays or operating a 10 W light-emitting diode bulb continuously for 1200 h. Piperacillin-tazobactam, amoxicillin-clavulanic acid, cefuroxime, metronidazole and meropenem together accounted for over 84% of total emissions, with piperacillin-tazobactam alone contributing 97.5 kg CO₂e and 41.6 kg of waste from 62 prolonged prescriptions.
In addition to patient safety risks, prolonged IV antimicrobial courses generate considerable environmental waste. Aligning AMS with sustainability goals may contribute to addressing the dual crises of antimicrobial resistance and climate change.
评估延长静脉注射抗菌药物疗程对环境的影响，并确定改进抗菌药物管理（AMS）实践的机会。
采用爱尔兰都柏林一家三级医院2023年1月至2024年12月的AMS查房数据进行回顾性横断面研究。审查了静脉注射抗菌药物处方、AMS关于停药或从静脉注射改为口服（IVOS）的建议以及开处方者的接受情况。利用已发表文献进行生命周期评估，以估计与静脉注射使用相关的碳足迹。
在审查的1929份抗菌药物处方中，58%（=1119份）采用静脉注射给药。在435份有AMS建议的静脉注射处方中，停止用药（=357份）或IVOS（=78份）的建议中，229份（52.6%）被接受，减少了106.5千克临床废物和261.2千克二氧化碳当量（CO₂e）排放。其余206份静脉注射处方（47.4%）被归类为延长静脉注射处方，产生了98.8千克临床废物和245.8千克CO₂e；平均每份处方产生0.48千克废物和1.19千克CO₂e。具体而言，每份延长处方的碳足迹相当于驾驶6.2公里、进行10次胸部X光检查或连续运行一个10瓦发光二极管灯泡1200小时。哌拉西林-他唑巴坦、阿莫西林-克拉维酸、头孢呋辛、甲硝唑和美罗培南合计占总排放量的84%以上，仅哌拉西林-他唑巴坦就产生了97.5千克CO₂e和41.6千克废物，涉及62份延长处方。
除了患者安全风险外，延长静脉注射抗菌药物疗程还会产生大量环境废物。使AMS与可持续发展目标保持一致可能有助于应对抗菌药物耐药性和气候变化这双重危机。
