Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey
Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey
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DOI：
10.1016/s2214-109x(18)30186-4
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发表时间：
2018-06-01
影响因子：
34.3
通讯作者：
Goossens, Herman
中科院分区：
文献类型：
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作者：
Versporten, Ann;Zarb, Peter;Goossens, Herman
全球点患病率调查（Global-PPS）建立了一个国际医院网络，以衡量全球范围内的抗菌药物处方和耐药性。我们的目的是评估抗菌药物处方和耐药性在医院住院patients.Methods方法，我们使用了标准化的监测方法，收集有关抗菌药物处方和耐药性的详细数据，从世界各地的医院，这是由联合国区域分组。基于互联网的调查包括2015年1月至9月期间某一天0800时在病房接受抗菌药物的所有住院患者（成人、儿童和新生儿）。医院分为一级、二级、三级（包括传染病医院）和儿科医院。五种主要的病房类型被定义为：内科病房、外科病房、重症监护病房、血液肿瘤病房和医学移植（骨髓或实体移植）病房。记录的数据包括患者特征、接受的抗菌剂、诊断、根据预定义列表的治疗适应症和处方质量标志物（例如，是否记录了停止或审查日期，以及是否存在并遵守当地处方指南）。结果2015年的全球PPS包括来自53个国家的303家医院的成人数据，其中包括8个中低收入国家和17个中高收入国家。3315个成人病房收治了86776名住院患者，其中29891人（34.4%）接受了至少一种抗菌药物。抗菌药物处方41213张，其中全身用药36792张（89.3%）。全球处方量最大的三种抗生素是青霉素和β-内酰胺酶抑制剂、第三代头孢菌素和氟喹诺酮类药物。碳青霉烯类最常在拉丁美洲和西亚和中亚使用。在接受至少一种抗菌药物的患者中，5926例（19.8%）接受了全身使用的靶向抗菌治疗，1769例（5.9%）接受了靶向至少一种多重耐药微生物的治疗。拉丁美洲（1518例[11.9%]）以及东亚和南亚（5363例[10.1%]）的医疗保健相关感染频率最高。总体而言，在31694例（76.9%）抗菌药物处方中记录了治疗原因，在15778例（38.3%）中记录了停止或审查日期。在36792张抗生素处方中，有7050张（19.2%）缺失当地抗生素指南，指南依从性为77.4%。解释全球PPS显示全球范围的监测可以通过自愿参与来完成。它提供了可量化的措施，以评估和比较世界各地医院患者抗生素处方和耐药性的数量和质量。这些数据将有助于通过教育和实践改变来提高抗生素处方的质量，特别是在没有工具监测医院抗生素处方的低收入和中等收入国家。
Background The Global Point Prevalence Survey (Global-PPS) established an international network of hospitals to measure antimicrobial prescribing and resistance worldwide. We aimed to assess antimicrobial prescribing and resistance in hospital inpatients.Methods We used a standardised surveillance method to collect detailed data about antimicrobial prescribing and resistance from hospitals worldwide, which were grouped by UN region. The internet-based survey included all inpatients (adults, children, and neonates) receiving an antimicrobial who were on the ward at 0800 h on one specific day between January and September, 2015. Hospitals were classified as primary, secondary, tertiary (including infectious diseases hospitals), and paediatric hospitals. Five main ward types were defined: medical wards, surgical wards, intensive-care units, haematology oncology wards, and medical transplantation (bone marrow or solid transplants) wards. Data recorded included patient characteristics, antimicrobials received, diagnosis, therapeutic indication according to predefined lists, and markers of prescribing quality (eg, whether a stop or review date were recorded, and whether local prescribing guidelines existed and were adhered to). We report findings for adult inpatients.Findings The Global-PPS for 2015 included adult data from 303 hospitals in 53 countries, including eight lower-middle- income and 17 upper-middle-income countries. 86 776 inpatients were admitted to 3315 adult wards, of whom 29 891 (34.4%) received at least one antimicrobial. 41 213 antimicrobial prescriptions were issued, of which 36 792 (89.3%) were antibacterial agents for systemic use. The top three antibiotics prescribed worldwide were penicillins with beta-lactamase inhibitors, third-generation cephalosporins, and fluoroquinolones. Carbapenems were most frequently prescribed in Latin America and west and central Asia. Of patients who received at least one antimicrobial, 5926 (19.8%) received a targeted antibacterial treatment for systemic use, and 1769 (5.9%) received a treatment targeting at least one multidrug-resistant organism. The frequency of health-care-associated infections was highest in Latin America (1518 [11.9%]) and east and south Asia (5363 [10.1%]). Overall, the reason for treatment was recorded in 31 694 (76.9%) of antimicrobial prescriptions, and a stop or review date in 15 778 (38.3%). Local antibiotic guidelines were missing for 7050 (19.2%) of the 36 792 antibiotic prescriptions, and guideline compliance was 77.4%.Interpretation The Global-PPS showed that worldwide surveillance can be accomplished with voluntary participation. It provided quantifiable measures to assess and compare the quantity and quality of antibiotic prescribing and resistance in hospital patients worldwide. These data will help to improve the quality of antibiotic prescribing through education and practice changes, particularly in low-income and middle-income countries that have no tools to monitor antibiotic prescribing in hospitals.