Comparison of the defined daily dose and days of treatment methods for evaluating the consumption of antibiotics and antifungals in the intensive care unit
Comparison of the defined daily dose and days of treatment methods for evaluating the consumption of antibiotics and antifungals in the intensive care unit
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DOI：
10.1016/j.medin.2019.06.008
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发表时间：
2020-06-01
影响因子：
3
通讯作者：
Diaz, E.
中科院分区：
文献类型：
--
作者：
Valles, J.;Fernandez, S.;Diaz, E.
目的：比较按限定日剂量（DDD）和按治疗天数（DOT）测量抗菌药物用量的差异。设计：回顾性分析多价ICU收治患者的临床和管理资料。环境：西班牙一所大学医院的ICU。患者：所有ICU收治的患者。干预措施:没有。感兴趣的主要变量：对于DDD方法，确定了世界卫生组织（世卫组织）指定的所有规定抗菌剂的DDD。对于DOT方法，一个DOT表示在给定的一天内使用单一药物，而不考虑使用的剂量。总DDDs和总DOTs归一化为100患者-天，以表示总使用情况。结果：研究期间共有2393例成人患者入住ICU。DDDs测量的抗菌药物总中位数为535.3 （IQR 319.8-845.5）比DOTs测量的344.0 (IQR 117.2-544.5), p < 0.001。当抗菌药物用量归一化为100患者-天时，用DDDs测量的抗菌药物用量中位数也更高[2.98/100患者-天（IQR 1.76-5.25） vs.用DOTs测量的1.89/100患者-天（IQR 0.64-3.0）， p < 0.001]。结论：对于危重患者使用的大多数抗菌和抗真菌药物，每100患者日DDDs和每100患者日DOTs的抗生素总使用量估计值不一致，因为给药剂量与世卫组织指定的DDD不同。应推荐DOT方法，以避免对成人危重患者DDDs的高估。(C) 2019 Elsevier Espana， S.L.U.；版权所有。
Objective: To compare the measurement of antimicrobial consumption by defined daily dose (DDD) versus by days of therapy (DOT).Design: Retrospective analysis of clinical and administrative data from patients admitted to a polyvalent ICU.Setting: ICU at a University Hospital in Spain.Patients: All patients admitted to the ICU.Interventions: None.Main variables of interest: For the DDD method, the World Health Organization (WHO)-assigned DDD was determined for the all the prescribed antimicrobials. For the DOT method, one DOT represented the administration of a single agent on a given day regardless of the number of doses administered. To express aggregate use, total DDDs and total DOTs were normalized to 100 patient-days.Results: During the study period, 2393 adult patients were admitted to the ICU. Total median antimicrobial drugs measured by DDDs was 535.3 (IQR 319.8-845.5) vs. 344.0 (IQR 117.2-544.5) when measured by DOTs, p < 0.001. When antimicrobial consumption was normalized to 100 patient-days, median antimicrobial consumption was also higher when measured by DDDs [2.98/100 patient-days (IQR 1.76-5.25) vs. 1.89/100 patient-days (IQR 0.64-3.0) when measured by DOTs, p < 0.001].Conclusions: For most antibacterial and antifungal drugs used in critically ill patients, estimates of aggregate antibiotic use by DDDs per 100 patient-days and DOTs per 100 patient-days are discordant because the administered dose is dissimilar from the WHO-assigned DDD. DOT methods should be recommended to avoid the overestimation that occurs with DDDs in adult critically ill patients. (C) 2019 Elsevier Espana, S.L.U. y SEMICYUC. All rights reserved.