Comparison of Defined versus Recommended versus Prescribed Daily Doses for Measuring Hospital Antibiotic Consumption
Comparison of Defined versus Recommended versus Prescribed Daily Doses for Measuring Hospital Antibiotic Consumption
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DOI：
10.1007/s15010-008-8138-4
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发表时间：
2009-08-01
期刊：
影响因子：
7.5
通讯作者：
Kern, W. V.
中科院分区：
文献类型：
--
作者：
de With, K.;Bestehorn, H.;Kern, W. V.
背景资料：医院抗生素使用量通常通过计算世界卫生组织/解剖治疗化学（WHO/ATC）指数（DDDs）定义的每日剂量数除以表示临床活动的分母（如占用床天数）来衡量。以前的研究发现DDDs，实践指南中推荐的日剂量（推荐日剂量，RDDs）和真正的处方日剂量（PDDs）之间存在差异。很少有研究量化这些discrimination.Methods：点患病率调查进行了定义的急性护理服务领域的一个大型德国州立大学医院。在调查当天有足够信息的941名成人住院患者中，267名（28%）在该特定日期有471份抗菌药物处方。在调查日之前的六天内，对这267名患者的任何其他抗菌药物处方进行检查，共获得2，304份PDD，其中1，754份为抗菌药物。后一种抗菌药物PDDs构成分析的基础。评价不同RDDs和DDDs的PDDs比例，并计算偏差。RDD剂量定义与当地实践指南推荐的肾功能正常的成人住院患者的抗生素治疗相一致。结果：在1，754份PDD中，625份符合DDD剂量定义（36%），1，024份（58%）符合RDD剂量定义（p < 0.01）。肾功能受损患者（肌酐清除率< 50 ml/min）的相应值分别为36%和42%。β-内酰胺类和大环内酯类的DDD差异较大（< 50%的处方剂量符合DDD定义），而氨基糖苷类的RDD差异较大。与PDDs相比，使用DDDs作为医院抗生素使用的衡量标准高估了抗生素使用量32%，而使用RDD则导致略微低估（-9%）。使用WHO/ATC目前定义的DDDs来衡量医院抗生素消耗量可能与抗生素使用密度的大幅高估有关，而使用实践指南衍生的RDD可能会产生更有效的抗生素暴露估计，这将有助于抗生素消费的横截面和纵向分析。
Background: Hospital antibiotic use is usually measured by calculating the volume as the number of daily doses defined by the World Health Organization/Anatomical Therapeutic Chemical (WHO/ATC) index (DDDs) divided by a denominator indicating clinical activity, such as the number of occupied bed days. Previous studies have found discrepancies between DDDs, daily doses as recommended in practice guidelines (recommended daily doses, RDDs), and truly prescribed daily doses (PDDs). Very few studies have quantified these discrepancies.Methods: A point prevalence survey was carried out in defined acute care service areas of a large German state university hospital. Of the 941 adult inpatients present on the day of the survey for whom adequate information was available, 267 (28%) had 471 prescriptions for antimicrobial drugs on that specific day. A check for any additional antimicrobial drug prescriptions for these 267 patients during the six days immediately preceding the survey day yielded a total of 2,304 PDDs, of which 1,754 were antibacterial agents. The Latter antibacterial drug PDDs constituted the basis for analysis. The proportion of PDDs different from RDDs and from DDDs was evaluated, and the deviations were calculated. RDD dose definitions corresponded to the local practice guideline recommendations of antibiotic therapy for adult hospitalized patients with normal renal function.Results: Of the 1,754 PDDs, 625 were matching DDD dose definitions (36%), and 1,024 (58%) were matching RDD dose definitions (p < 0.01). Corresponding values for patients with impaired renal function (creatinine clearance < 50 ml/min) were 36% and 42%, respectively. Large DDD discrepancies (< 50% of prescribed doses matching DDD definitions) were noted for betalactams and macrolides, while large RDD discrepancies were observed for aminoglycosides. Compared with PDDs, the use of DDDs as the measurement of hospital antibiotic use overestimated antibiotic use volumes by 32%, while the use of RDD led to a slight underestimation (-9%).Conclusions: The use of DDDs as currently defined by WHO/ATC for measuring hospital antibiotic consumption may be associated with a substantial overestimation of antibiotic use density, while using practice guideline-derived RDDs may yield more valid antibiotic exposure estimates that would be helpful in cross-sectional and longitudinal analyses of antibiotic consumption.