The Standardized Antimicrobial Administration Ratio: A New Metric for Measuring and Comparing Antibiotic Use
The Standardized Antimicrobial Administration Ratio: A New Metric for Measuring and Comparing Antibiotic Use
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DOI：
10.1093/cid/ciy075
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发表时间：
2018-07-15
影响因子：
11.8
通讯作者：
Pollock, Daniel A.
中科院分区：
文献类型：
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作者：
van Santen, Katharina L.;Edwards, Jonathan R.;Pollock, Daniel A.
背景。为了提供标准化、风险调整后的方法来总结抗生素使用 (AU)，使医院能够随时间跟踪其 AU 并将其 AU 数据与国家基准进行比较，疾病控制和预防中心开发了标准化抗菌药物管理比率 (SAAR) 方法。向国家医疗保健安全网络 (NHSN) AU 选项报告的医院以电子方式收集并提交汇总的 AU 数据，作为每个患者在场天数的抗菌治疗天数。 SAAR 是针对特定的 NHSN 成人和儿童患者护理场所开发的，涵盖五种抗菌药物类别：(1) 主要用于医院发病/多重耐药细菌的广谱药物； (2) 主要用于社区获得性感染的广谱药物； (3)抗耐甲氧西林金黄色葡萄球菌制剂； (4) 主要用于预防手术部位感染的药物； (5) 所有抗生素药物。 SAAR 是观察到的使用与预测的使用比率，其中预测的使用是根据统计模型估计的； SAAR 为 1 表示观察到的使用情况和预测的使用情况相等。结果。大多数地点级别的 SAAR 在统计上与 1 存在显着差异：成人地点比 1 低多达 52%，比 1 高多达 41%。成人和儿童 ICU 的中位 SAAR 范围为 0.667-1.119。 SAAR 分布可作为与国家 SAAR 的外部比较。结论。这是第一个综合 AU 指标，它使用以电子方式报告给国家监测系统的即时护理、抗菌药物管理数据，以便在多家医院之间进行风险调整后的 AU 比较。经国家质量论坛认可，SAAR 提供了 AU 基准，管理计划可利用这些基准来帮助推动改进。
Background. To provide a standardized, risk-adjusted method for summarizing antibiotic use (AU), enable hospitals to track their AU over time and compare their AU data to national benchmarks, the Centers for Disease Control and Prevention developed the Standardized Antimicrobial Administration Ratio (SAAR).Methods. Hospitals reporting to the National Healthcare Safety Network (NHSN) AU Option collect and submit aggregated AU data electronically as antimicrobial days of therapy per patient days present. SAARs were developed for specific NHSN adult and pediatric patient care locations and cover five antimicrobial agent categories: (1) broad-spectrum agents predominantly used for hospital-onset/multi-drug resistant bacteria; (2) broad-spectrum agents predominantly used for community-acquired infections; (3) anti-methicillin-resistant Staphylococcus aureus agents; (4) agents predominantly used for surgical site infection prophylaxis; and (5) all antibiotic agents. The SAAR is an observed-to-predicted use ratio where predicted use is estimated from a statistical model; a SAAR of 1 indicates that observed use and predicted use are equal.Results. Most location-level SAARs were statistically significantly different than 1: adult locations up to 52% lower than 1 and up to 41% higher than 1. Median SAARs in adult and pediatric ICUs had a range of 0.667-1.119. SAAR distributions serve as an external comparison to national SAARs.Conclusions. This is the first aggregate AU metric that uses point-of-care, antimicrobial administration data electronically reported to a national surveillance system to enable risk-adjusted, AU comparisons across multiple hospitals. Endorsed by the National Quality Forum, SAARs provide AU benchmarks that stewardship programs can use to help drive improvements.