Measurement of adult antibacterial drug use in 130 US hospitals: Comparison of defined daily dose and days of therapy
Measurement of adult antibacterial drug use in 130 US hospitals: Comparison of defined daily dose and days of therapy
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DOI：
10.1086/511640
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发表时间：
2007-03-01
影响因子：
11.8
通讯作者：
MacDougall, Conan
中科院分区：
文献类型：
--
作者：
Polk, Ronald E.;Fox, Christina;MacDougall, Conan
背景建议医院测量抗生素的使用并监测其与耐药性的关系。世界卫生组织推荐的指标是限定日剂量（DDD）。另一种测量方法是治疗天数（DOT）。本研究的目的是对比这些措施。我们测量了2002年8月1日至2003年7月31日期间从130家美国医院出院的成年人使用的50种抗菌药物。在1，795，504例患者中，1，074，174例至少接受了1剂抗菌药物（59.8%）。通过每1000患者日的DDDs数量和每1000患者日的DOT数量测量的总抗菌药物使用的平均值（+/-标准差）没有显著差异（分别为792 +/- 147和776 +/- 120; P = 0.137），尽管相关性很差（r = 0.603）。对于某些药物，如左氧氟沙星和利奈唑胺，每1000患者日的DDDs和每1000患者日的DOT之间没有显著差异，因为每日给药剂量几乎与DDD相当。当给药剂量超过DDD时，如氨苄西林-舒巴坦和头孢吡肟，基于每1000患者日的DDDs的估计使用量显著超过基于每1000患者日的DOT的估计使用量（P < .001）。当给药剂量小于DDD时，如哌拉西林-他唑巴坦和头孢曲松，基于DDDs/1000 patient-d的估计使用量显著低于基于DOT/1000 patient-d的估计使用量（P < .001）。对于许多常用的抗菌药物，通过每1000患者日的DDD和每1000患者日的DOT测量医院抗生素总使用量是不一致的，因为给药剂量与世界卫生组织推荐的DDD不同。DDD方法可用于基准目的，但不能用于推断DOT的数量或许多抗菌药物的相对使用。
Background. Hospitals are advised to measure antibiotic use and monitor its relationship to resistance. The World Health Organization's recommended metric is the defined daily dose (DDD). An alternative measure is the number of days of therapy (DOT). The purpose of this study was to contrast these measures.Methods. We measured the use of 50 antibacterial drugs that were administered to adults who were discharged from 130 US hospitals during 1 August 2002 - 31 July 2003.Results. Of 1,795,504 patients, 1,074,174 received at least 1 dose of an antibacterial drug (59.8%). The mean (+/- standard deviation) of total antibacterial drug use measured by the number of DDDs per 1000 patient-days and the number of DOTs per 1000 patient-days were not significantly different (792 +/- 147 and 776 +/- 120 respectively; P = .137), although the correlation was poor (r = 0.603). For some individual drugs, such as levofloxacin and linezolid, there was no significant difference between DDDs per 1000 patient-days and DOTs per 1000 patient-days, because the administered daily dosage was nearly equivalent to the DDD. When the administered dosage exceeded the DDD, such as for ampicillin-sulbactam and cefepime, estimates of use based on DDDs per 1000 patient-days significantly exceeded those based on DOTs per 1000 patient-days (P < .001). When the administered dosage was less than the DDD, such as for piperacillin-tazobactam and ceftriaxone, estimates of use based on DDDs per 1000 patient-days were significantly lower than those based on DOTs per 1000 patient-days (P < .001).Conclusion. The measurement of aggregate hospital antibiotic use by DDDs per 1000 patient-days and DOTs per 1000 patient- days is discordant for many frequently used antibacterial drugs, because the administered dose is dissimilar from the DDD recommended by the World Health Organization. DDD methods are useful for benchmarking purposes but cannot be used to make inferences about the number of DOTs or relative use for many antibacterial drugs.