Antimicrobial use across six referral hospitals in Tanzania: a point prevalence survey.
Antimicrobial use across six referral hospitals in Tanzania: a point prevalence survey.
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坦桑尼亚六家推荐医院的抗菌使用：观点患病率调查。
DOI：
10.1136/bmjopen-2020-042819
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发表时间：
2020-12-15
期刊：
影响因子：
2.9
通讯作者：
Konduri N
中科院分区：
文献类型：
--
作者：
Seni J;Mapunjo SG;Wittenauer R;Valimba R;Stergachis A;Werth BJ;Saitoti S;Mhadu NH;Lusaya E;Konduri N
使用世卫组织点流行率调查(PPS)方法，描述坦桑尼亚六家转诊医院中抗菌素使用的流行率和与抗菌剂使用相关的因素，为医院特定的抗菌剂管理方案提供信息。横断面分析研究。坦桑尼亚的六家转诊医院。不分年龄和性别的患者(n=948)在调查的每天8：00前在6个转介医院病房住院的患者被纳入2019年12月。使用世卫组织PPS方法，收集了有关医院、病房、患者、抗生素和抗生素适应症的数据。我们分析了转诊医院、病房、适应症和患者特征作为主要结果的抗生素使用情况。我们还介绍了遵守坦桑尼亚标准治疗指南(STG)和世卫组织意识到的抗生素分类。约62.3%的住院患者服用了抗生素，主要来自抗生素接入组(头孢曲松、甲硝唑或氨苄西林-氯唑西林)。坦桑尼亚STG的抗生素处方总体依从性很高(84.0%)，除了塞库图雷地区转诊医院(68.0%)和马文尼地区转诊医院(57.8%)。抗生素处方最常见的适应症是社区获得性感染(39.8%)。2岁以下儿童(OR1.73，95%CI1.02~2.92，p=0.039)、外科病房入院(OR4.90，95%CI2.87~8.36，p<；0.001)和儿科病房入院(OR3.93，95%CI2.16~7.15，p<；0.001)与抗生素使用几率增加相关。根据培养和药敏结果，591名患者中只有2人开了抗生素。抗生素的经验性使用很常见，而抗生素的接入组主要是在2岁以下的儿童以及住进外科和儿科病房的患者中使用。这些医院缺乏对抗菌素敏感性检测服务的利用，需要紧急干预。建议将抗生素使用的常规监测作为坦桑尼亚抗生素管理方案的一部分。
To delineate the prevalence and factors associated with antimicrobial use across six referral hospitals in Tanzania using WHO point prevalence survey (PPS) methodology to inform hospital-specific antimicrobial stewardship programmes. Cross-sectional analytical study. Six referral hospitals in Tanzania. Patients irrespective of age and gender (n=948) admitted in the six referral hospital wards before 8:00 hours on each day of the survey were included in December 2019. Using the WHO PPS methodology, data on hospitals, wards, patients, antibiotics, and indications for antibiotics were collected. We analysed the prevalence of antibiotic use by referral hospital, ward, indication and patient characteristics as the main outcomes. We also described adherence to the Tanzania Standard Treatment Guidelines (STG) and WHO’s AWaRe categorisation of antibiotics. Approximately 62.3% of inpatients were prescribed antibiotics, predominantly from the Access group of antibiotics (ceftriaxone, metronidazole or ampicillin–cloxacillin). The overall adherence of antibiotic prescriptions to the Tanzania STG was high (84.0%), with the exception of Sekou Toure Regional Referral Hospital (68.0%) and Maweni Regional Referral Hospital (57.8%). The most common indication for antibiotic prescriptions was community-acquired infections (39.8%). Children less than 2 years of age (OR 1.73, 95% CI 1.02 to 2.92, p=0.039); admission to surgical wards (OR 4.90, 95% CI 2.87 to 8.36, p <0.001); and admission to paediatric wards (OR 3.93, 95% CI 2.16 to 7.15, p <0.001) were associated with increased odds of antibiotic use. Only 2 of 591 patients were prescribed antibiotics based on culture and antimicrobial susceptibility testing results. Empirical use of antibiotics is common, and the Access group of antibiotics is predominantly prescribed in children less than 2 years and patients admitted to surgical and paediatric wards. Lack of utilisation of antimicrobial susceptibility testing services in these hospitals requires urgent interventions. Routine monitoring of antibiotic use is recommended to be part of antibiotic stewardship programmes in Tanzania.
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