Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries
Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries
复制标题
DOI：
10.1016/s2214-109x(19)30071-3
复制
发表时间：
2019-07-01
影响因子：
34.3
通讯作者：
Gawrys, G.
中科院分区：
文献类型：
--
作者：
Hsia, Yingfen;Lee, Brian R.;Gawrys, G.
提高医院抗生素使用的质量是世卫组织对抗抗生素耐药性全球行动计划的一个主要目标。世卫组织基本药物清单获取、观察和储备（AWaRe）分类可以促进全球广泛适用的简单管理干预措施。我们的目的是目前的儿科AWaRe抗生素的使用模式，可用于当地和国家的管理interventions.Methods 1天的点患病率调查抗生素处方数据相结合，从两个独立的全球网络：全球抗菌药物耐药性，处方，疗效在新生儿和儿童和全球点患病率调查抗菌药物消费和耐药性网络。我们纳入了在调查当天接受至少一种抗生素治疗的19岁以下住院患者。WHO AWaRe分类被用来描述整体抗生素的使用评估之间的变化使用的访问，手表，储备抗生素，新生儿和儿童和最常见的临床indications.Findings的23 572例患者包括来自56个国家，18305名儿童（77.7%）和5267名新生儿（22.3%）。在所有抗生素处方中，儿童使用可获得抗生素的比例从7.8%（中国）到61.2%（斯洛文尼亚）不等。儿童使用Watch抗生素的比例在伊朗最高（77.3%），在芬兰最低（23.0%）。新生儿中，Access抗生素使用率最高的是新加坡（100.0%），最低的是中国（24.2%）。所有国家的储备抗生素使用率都很低。在下呼吸道感染和新生儿败血症中AWaRe抗生素使用的临床综合征特异性模式的主要差异在WHO区域和国家之间观察到。AWaRe分类可能用作抗生素适当使用的简单交通灯指标。未来的工作重点应是在AWaRe指数的基础上制定和评估儿科抗生素管理计划。版权所有（C）2019作者。爱思唯尔有限公司出版
Background Improving the quality of hospital antibiotic use is a major goal of WHO's global action plan to combat antimicrobial resistance. The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate simple stewardship interventions that are widely applicable globally. We aimed to present data on patterns of paediatric AWaRe antibiotic use that could be used for local and national stewardship interventions.Methods 1-day point prevalence survey antibiotic prescription data were combined from two independent global networks: the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children and the Global Point Prevalence Survey on Antimicrobial Consumption and Resistance networks. We included hospital inpatients aged younger than 19 years receiving at least one antibiotic on the day of the survey. The WHO AWaRe classification was used to describe overall antibiotic use as assessed by the variation between use of Access, Watch, and Reserve antibiotics, for neonates and children and for the commonest clinical indications.Findings Of the 23 572 patients included from 56 countries, 18305 were children (77.7%) and 5267 were neonates (22.3%). Access antibiotic use in children ranged from 7.8% (China) to 61.2% (Slovenia) of all antibiotic prescriptions. The use of Watch antibiotics in children was highest in Iran (77.3%) and lowest in Finland (23.0%). In neonates, Access antibiotic use was highest in Singapore (100.0%) and lowest in China (24.2%). Reserve antibiotic use was low in all countries. Major differences in clinical syndrome-specific patterns of AWaRe antibiotic use in lower respiratory tract infection and neonatal sepsis were observed between WHO regions and countries.Interpretation There is substantial global variation in the proportion of AWaRe antibiotics used in hospitalised neonates and children. The AWaRe classification could potentially be used as a simple traffic light metric of appropriate antibiotic use. Future efforts should focus on developing and evaluating paediatric antibiotic stewardship programmes on the basis of the AWaRe index. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.