Hospital- and patient-related factors associated with differences in hospital antibiotic use: analysis of national surveillance results.
Hospital- and patient-related factors associated with differences in hospital antibiotic use: analysis of national surveillance results.
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DOI：
10.1186/s13756-014-0040-5
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发表时间：
2014
影响因子：
5.5
通讯作者：
Reikvam Å
中科院分区：
文献类型：
--
作者：
Haug JB;Berild D;Walberg M;Reikvam Å
抗生素使用的监测数据越来越多地被用于基准目的，但缺乏关于医院和患者相关因素如何影响医院抗生素使用的研究。我们的目标是确定可能导致抗生素使用差异的因素。根据2006年至2011年的药房销售数据，分析了22家卫生企业(HES)的所有抗生素、所有青霉素类和广谱抗生素的使用情况。抗生素的使用是用世界卫生组织定义的日剂量(DDD)和医院调整的DDDS来衡量的，每一种都与卧床天数(BDS)和出院次数有关。对于每一种HE，所有的临床专业都包括在内，HE水平的汇总数据构成了分析的基础。从经过验证的国家数据库提取的14个可能与观察到的抗生素使用有关的变量在12个多元线性回归模型中进行了检验，其中有四个不同的测量单位：DDD/100 BDS、DDD/100排放、haDDD/100 BDS和haDDD/100排放。有六个变量与抗生素的使用独立相关，但变量模式取决于回归模型。高水平的护士配置，高比例的短(<；2天)和长(>；10天)住院，传染病是ICD-10的主要诊断代码，以及与手术诊断相关的群体与所有抗生素的高使用率相关。在12个模型中，大学附属的HES有8个模型的抗生素使用水平低于其他机构，并且具有很高的解释性。广谱抗生素的使用与住院时间的长短密切相关。有一个残留差异(所有抗生素30%-50%；广谱抗生素60%-70%)我们的分析无法解释。与医院抗生素使用相关的因素大多是不可改变的。通过对这些因素进行调整，将更容易评估和理解观察到的医院间抗生素使用的差异。因此，医院之间的差异可以更有信心地采取行动。剩余变异被认为在很大程度上反映了与处方者相关的因素。
Surveillance data of antibiotic use are increasingly being used for benchmarking purposes, but there is a lack of studies dealing with how hospital- and patient-related factors affect antibiotic utilization in hospitals. Our objective was to identify factors that may contribute to differences in antibiotic use. Based on pharmacy sales data (2006–2011), use of all antibiotics, all penicillins, and broad-spectrum antibiotics was analysed in 22 Health Enterprises (HEs). Antibiotic utilization was measured in World Health Organisation defined daily doses (DDDs) and hospital-adjusted (ha)DDDs, each related to the number of bed days (BDs) and the number of discharges. For each HE, all clinical specialties were included and the aggregated data at the HE level constituted the basis for the analyses. Fourteen variables potentially associated with the observed antibiotic use – extracted from validated national databases – were examined in 12 multiple linear regression models, with four different measurement units: DDD/100 BDs, DDD/100 discharges, haDDD/100 BDs and haDDD/100 discharges. Six variables were independently associated with antibiotic use, but with a variable pattern depending on the regression model. High levels of nurse staffing, high proportions of short (<2 days) and long (>10 days) hospital stays, infectious diseases being the main ICD-10 diagnostic codes, and surgical diagnosis-related groups were correlated with a high use of all antibiotics. University affiliated HEs had a lower level of antibiotic utilization than other institutions in eight of the 12 models, and carried a high explanatory strength. The use of broad-spectrum antibiotics correlated strongly with short and long hospital stays. There was a residual variance (30%–50% for all antibiotics; 60%–70% for broad-spectrum antibiotics) that our analysis did not explain. The factors associated with hospital antibiotic use were mostly non-modifiable. By adjusting for these factors, it will be easier to evaluate and understand observed differences in antibiotic use between hospitals. Consequently, the inter-hospital differences can be more confidently acted upon. The residual variation is presumed to largely reflect prescriber-related factors.
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影响因子：
5.2
作者：
Kuster, Stefan P.;Ruef, Christian;Weber, Rainer
通讯作者：
Weber, Rainer
影响因子：
7.5
作者：
de With, K.;Bestehorn, H.;Kern, W. V.
通讯作者：
Kern, W. V.
影响因子：
2.5
作者：
Harrington, C;Swan, JH
通讯作者：
Swan, JH
影响因子：
7.5
作者：
de With, K.;Maier, L.;Kern, W. V.
通讯作者：
Kern, W. V.
影响因子：
3.1
作者：
MAKI, DG;SCHUNA, AA
通讯作者：
SCHUNA, AA