Validation of adapted daily dose definitions for hospital antibacterial drug use evaluation: a multicentre study
Validation of adapted daily dose definitions for hospital antibacterial drug use evaluation: a multicentre study
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DOI：
10.1093/jac/dkx244
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发表时间：
2017-10-01
影响因子：
5.2
通讯作者：
Kern, Winfried V.
中科院分区：
文献类型：
--
作者：
Forst, Gesche;de With, Katja;Kern, Winfried V.
背景：WHO/ATC（解剖治疗化学）指数DDD（WHO-DDD）常用于药物消耗测量。WHO-DDD和医院实际处方日剂量（PDD）之间的差异促使替代剂量定义适应医院实践指南[推荐日剂量（RDD）]中推荐的剂量。为了验证RDD，我们在24家急性护理医院进行了改良的点患病率调查，并记录了调查当天给予4226名成人患者的20620 PDD抗生素，前六天。结果：PDD对应的RDD率高于WHO-DDD对应的RDD率（合并数据，55%比30%），各医院样本间差异相似，但因药物/药物类别、给药途径、适应症和肾功能而异。RDD总体低估了实际消耗量14%，而WHO-DDD高估了抗菌药物总消耗量28%（汇总数据; RDD中位数-10% vs WHO-DDD + 32%）。β-内酰胺类药物的估计用药量与实际用药量的偏差最大（RDD-11% vs WHO-DDD + 49%），尤其是青霉素类如果使用WHO-DDD，则为-11% vs + 64%。医院抗生素消耗监测系统使用当前世卫组织-DDD应根据药物类别解决实际处方和消费估计值之间的不均匀差异，这可能导致基准分析中的错误分类。我们建议使用经验证的RDD作为WHO-DDD的补充措施进行详细分析。
Background: The WHO/ATC (Anatomical Therapeutic Chemical) index DDD (WHO-DDD) is commonly used for drug consumption measurement. Discrepancies between WHO-DDD and actual prescribed daily doses (PDD) in hospitals have prompted alternative dose definitions adapted to doses recommended in hospital practice guidelines [recommended daily doses (RDD)].Methods: In order to validate RDD we performed modified point prevalence surveys in 24 acute care hospitals and recorded 20620 PDD of antibiotics given to 4226 adult patients on the day of the survey and the 6 preceding days. We calculated RDD and WHO-DDD and compared them with PDD.Results: The rate of RDD corresponding to PDD was higher than the corresponding rate for WHO-DDD (pooled data, 55% versus 30%) and the differences were similar across the hospital sample, but varied according to drug/drug class, route of administration, indication and renal function. RDD underestimated actual consumption by 14% overall, while WHO-DDD overestimated total antibacterial consumption by 28% (pooled data; median values RDD -10% versus WHO-DDD + 32%). The deviations of estimated from actual drug use volumes were largest for beta-lactams (RDD -11% versus WHO-DDD + 49%), in particular for penicillins (-11% versus + 64%), if WHO-DDD were used.Conclusions: Hospital antibiotic consumption surveillance systems using current WHO-DDD should address the uneven discrepancies between actual prescribing and consumption estimates according to drug class that may lead to misclassification in benchmark analyses. We recommend using validated RDD as a supplementary measure to the WHO-DDD for detailed analyses.