Optimizing antibiotic use in hospitals: the role of population-based antibiotic surveillance in limiting antibiotic resistance. Insights from the society of infectious diseases pharmacists

To minimize antibiotic resistance, pharmacists increasingly are becoming involved in antibiotic surveillance, formulation of antibiotic use policies, and day-to-day control of problematic antibiotic use. Population-based antibiotic surveillance has become common with the proliferation of electronic databases. The most widely applied measure of antibiotic consumption is the defined daily dose/1000 patient days. Most studies correlating antibiotic consumption with resistance have focused on antibiogram-related end points; antibiogram data generally reflect institutional nosocomial infection patterns. Most study designs have been derived from traditional epidemiology such as case-control with regression modeling or simple linear regression; however, these methods have limitations. Several experimental designs show promise. Many historical-control studies, including a multicentered study, suggest that population-based antibiotic surveillance and policy intervention can decrease antibiotic resistance in hospitals. Further research on the relationships among antibiotic surveillance, structured antibiotic policy interventions, and other microbiologic, patient-oriented, and economic end points is needed.     

降钙素原对儿童社区获得性肺炎抗菌药物选择及疗效的影响

[摘要]目的:探讨血清降钙素原(PCT)对指导儿童社区获得性肺炎(CAP)抗菌药物选择以及疗效的影响。方法:采用前瞻性研究方法,收集2014年5月至2016年5月我院儿科收治的172例儿童CAP患儿的临床资料,随机分为血清PCT指导抗菌药物选择组(观察组)和临床指导标准选择组(对照组)各86例,比较两组患儿抗菌药物使用率、抗菌药物使用时间、疗效等指标。结果:观察组患儿抗菌药物使用率、抗菌药物使用时间以及两种抗菌药物联用率均低于对照组(P均<0.05)。两组患儿抗菌药物不良反应发生率、退热时间、住院时间以及复发率比较差异均无统计学意义(P均>0.05)。结论:应用血清PCT指导CAP患儿抗菌药物的使用能显著降低抗菌药物使用率、缩短使用时间且不影响临床疗效,有助于合理使用抗菌药物。     

National campaigns to improve antibiotic use

High levels of antibiotic consumption are driving levels of bacterial resistance that threaten public health. Nonetheless, antibiotics still provide highly effective treatments for common diseases with important implications for human health. The challenge for public education is to achieve a meaningful reduction in unnecessary antibiotic use without adversely affecting the management of bacterial infections. This paper focuses on the lessons learned from national campaigns in countries (Belgium and France) with high antibiotic use. Evaluation of these national campaigns showed the importance of television advertising as a powerful medium to change attitudes and perhaps also behaviour with regard to antibiotics. Moreover, in both countries, strong evidence suggested reduced antibiotic prescribing. However, adverse effects associated with a reduction in antibiotic prescribing were not monitored. We conclude that carefully designed mass education campaigns could improve antibiotic use nationally and should be considered in countries with high antibiotic use. However, these campaigns should employ techniques of social marketing and use appropriate outcome measures. The benefits and risks of such campaigns have been less well established in countries where antibiotic use is already low or declining.     

抗菌药物专项整治活动对某院急诊急性上呼吸道感染患者抗菌药物使用情况的影响

目的:了解卫生部抗菌药物专项整治活动对某院急诊急性上呼吸道感染患者抗菌药物使用状况的影响。方法:回顾性分析2010年7月-2011年6月(整治前)和2011年7月-2012年6月(整治后)某院急诊急性上呼吸道感染全部病例在整治活动前后抗菌药物应用情况的差异。结果:整治后上呼吸道感染患者的每次抗菌药费用占总费用的比例由95.59%下降到78.99%;抗菌药物品种及类别结构得到优化和调整;不合理用药比例由20.25%下降到13.54%。结论:整治活动后抗菌药物应用指征的掌握有所改进;用药指标有所改进;抗菌药物使用剂量与用法不合理现象仍需改善。抗菌药物整治活动在该院取得了一定的效果,有效地促进了抗菌药物合理使用。     

专项整治活动后我院抗菌药物应用分析

目的：对我院住院患者抗菌药物的使用进行分析,了解抗菌药物整治效果,并为下一步的管理提出建议。方法：采用回顾性分析方法,对2011、2012年我院住院患者抗菌药物临床应用数据进行统计、分析。结果：2012年抗菌药物在销售金额、用药频度（DDDs）、抗菌药物使用强度（AUD）、使用率、分级使用、基本药物应用等方面比2011年均有明显下降。结论：2012年我院抗菌药物的应用都有明显好转,整治效果显著,但AUD还未达标。医院仍应加强系统化管理,注重对经验治疗用药的分析,对价格昂贵且用药频次高的品种重点跟踪监测,规范抗菌药物的临床应用。     

2010—2012年防城港市中医医院住院患者抗菌药物应用分析

目的：了解我院住院患者抗菌药物的应用情况及趋势,为临床合理用药及管理提供参考和依据。方法：对2010—2012年我院住院患者抗菌药物的品种、销售金额、使用率、抗菌药物使用强度（AUD）、用药频度（DDDs）、限定日费用（DDC）、全院及各主要科室使用抗菌药物情况进行统计、分析。结果：2010—2012年我院住院患者抗菌药物人均使用品种数、抗菌药物使用率及AUD呈逐年下降趋势;抗菌药物销售金额呈逐年上升趋势,头孢菌素类一直居销售金额排序首位。结论：我院住院患者抗菌药物使用情况趋于合理,临床药师参与临床查房对合理应用抗菌药物起到了积极作用。个别科室仍存在认识误区,仍有不规范使用抗菌药物的现象,有待进一步加强管理和规范。     

Increased toxicity of oral antibiotics in sodium-deficient rats

The toxicity of an oral antibiotic mixture used to decontaminate the gastrointestinal tract of experimental animals was compared in rats with a normal sodium intake to rats on a sodium-deficient diet. Sodium-depleted rats are quite sensitive to the oral antibiotic mixture. The antibiotic mixture was nephrotoxic, resulting in necrosis of the proximal tubules. Therefore, since the parenteral administration of antibiotics also produced necrosis of the proximal tubules, the mechanism of antibiotic toxicity in sodium-deficient rats is not influenced by the route of antibiotic administration.     

南阳市第一人民医院专项整治活动后抗菌药物应用分析

目的：了解我院2011年6月抗菌药物专项整治活动开展以来全院抗菌药物应用情况,为后续管理提供指导依据,以进一步促进抗菌药物的规范使用。方法：采用回顾性调查分析方法,对自2011年6月整治活动开展1年以来全院抗菌药物使用情况：月平均用药频度（DDDs）、住院患者抗菌药物使用率、抗菌药物使用强度（AUD）及抗菌药物销售金额占药品总销售金额比例等数据进行统计、分析。结果：抗菌药物应用专项整治后,我院住院患者抗菌药物使用率和AUD已达卫生部要求;抗菌药物销售金额占药品总销售金额的比例明显下降但仍超出规定标准;月平均DDDs较整治前降低了46.4%（20 778.68/38 767.09）;抗菌药物分级管理效果明显,越权限使用现象明显减少;Ⅰ类切口手术预防性使用率大幅降低、用药合理性明显改善;介入手术预防性用药合理性也明显改善。结论：本次抗菌药物专项整治活动初见成效,取得了阶段性成绩,但对抗菌药物的合理应用仍需不断查找问题,督促整改。     

我国幽门螺旋杆菌抗生素耐药现状

幽门螺旋杆菌(H.Pylori)与多种消化系统的发病密切相关,所以有效的根治幽门螺旋杆菌具有重要的临床意义。但随着抗生素的大量使用,幽门螺旋杆菌的耐药也日趋严重,不同地区和不同人群呈现不同的耐药趋势。掌握其耐药趋势对于选择高效、合理的抗生素根除幽门螺杆菌,控制因幽门螺杆菌导致的疾病发生具有重要意义。本文就今年来国内不同地区、不同年龄、不同治疗经历、不同疾病幽门螺旋杆菌的抗生素耐药情况做一综述。     

益生菌益生元复合制剂对头孢曲松引起的肠道菌群及免疫异常改善效果的研究

摘要：目的 探究由乳双歧杆菌HN019、乳双歧杆菌V9与益生元共同组成的益生菌、益生元复合制剂对头孢曲松引起的 小鼠免疫异常以及肠道菌群失调的改善效果。方法 45只四周龄雄性Balb/c小鼠随机分为3组,分别灌胃生理盐水、头孢曲松以 及头孢曲松+益生菌复合制剂30d后,检测受试小鼠的体重、逆转录实时荧光定量PCR(RT-qPCR)分析脾脏细胞中免疫細胞因子的 mRNA表达、用RT-qPCR和高通量测序技術检测粪便双歧杆菌含量以及粪便细菌的构成。结果 头孢曲松+复合制剂组受试小鼠 体重显著低于空白组(P<0.05)。头孢曲松组脾脏IL-10 mRNA表达量有下降趋势,头孢曲松+益生菌复合制剂组受试小鼠脾脏IL- 10 mRNA表达量显著高于头孢曲松组(P<0.05)。头孢曲松组受试小鼠粪便双歧杆菌含量有下降趋势,头孢曲松+益生菌复合制剂 组受试小鼠粪便双歧杆菌含量显著高于头孢曲松组(P<0.05)。头孢曲松组和头孢曲松+复合制剂组与空白组相比,受试小鼠α-多 样性有不同程度的降低。头孢曲松组拟杆菌门减少,厚壁菌门和肠球菌属增多。头孢曲松+复合制剂组与头孢曲松组相比,受 试小鼠厚壁菌门与肠球菌属的相对丰度减少,放线菌门增加。结论 头孢曲松可导致宿主免疫功能异常,肠道双歧杆菌等有益 菌减少,肠道菌群整体结构紊乱。益生菌、益生元复合制剂可通过促进抗炎因子的产生改善了宿主免疫功能,并通过增加双歧 杆菌和减少某些致病菌在一定程度上改善了头孢曲松导致的宿主肠道菌群异常、促进肠道健康。     

我院部分科室抗生素临床应用的调查

目的:了解我院抗生素应用情况,为临床安全、合理、有效的使用抗生素提供参考。方法:随机抽取2005年7月至9月出院病历662份,对抗生素的应用、联用及防治性用药情况进行回顾性分析。结果:在所调查的662份病历中,有468例患者使用了抗生素,占70.69%,其中,用于治疗者184例,占39.32%,用于预防者284例,占60.68%;使用一种抗生素者197例,占42.09%,联用二种抗生素者168例,占35.90%,联用三种以上者103例,占22.01%。结论:加强抗菌药物的应用与管理,规范临床使用抗生素势在必行。     

慢性阻塞性肺病急性期致病菌及药物敏感分析

目的 探讨慢性阻塞性肺病急性感染期致病菌变化及其耐药性,为合理应用抗生素提供可靠依据。方法 对46例慢性阻塞性肺病急性感染期患者与30例急性下呼吸道感染进行痰菌培养及药物敏感的对照分析。结果 慢性阻塞性肺病急性感染期多为混合菌感染,革兰氏阳性球菌感染减少,革兰氏阴性杆菌、真菌、厌氧菌增多,且耐药性严重,与对照组比较有显著意义。结论 监测慢性阻塞性肺病急性感染期致病菌变化及其耐药性,可指导临床选择抗生素,预测病情进展。     

解放军第291医院围术期抗菌药物合理应用分析

目的:调查我院各科室手术患者围术期抗菌药物应用情况,分析其用药合理性,以提高围术期抗菌药物合理应用水平。方法:回顾性随机抽查2006年1月—2011年4月全院各科室的218份手术病例资料,了解围术期抗菌药物的使用情况,从适应证、药物选择、各类切口围术期用药时间及持续时间、联合用药等,根据《抗菌药物临床应用指导原则》,对各类切口围术期抗菌药物应用情况进行分析。结果:218例病例围术期使用抗菌药物216例,使用率为99.0%,2例未使用药物,占0.92%。216例围术期患者抗菌药物的应用存在较多不合理现象,主要表现在药物选择不当、药物选择起点高、手术前多日无指征应用抗菌药物、给药时机不当、频繁更换药品、术后用药时间过长等。结论:我院围术期抗菌药物应用不合理现象较多,应加强管理,以保证临床用药安全、有效、经济。     

21360张门诊处方抗菌药物使用分析

目的：了解南宁市宾阳县妇幼保健院门诊抗菌药物的使用情况.方法：随机抽取该院2013年门诊处方21 360张,对抗菌药物使用情况进行统计分析.结果：使用抗菌药物处方共4 614张,抗菌药物使用率为21.60％.其中,抗菌药物使用不合理处方656张,占抽取总处方数的3.07％,占抗菌药物处方数的14.22％.不合理用药情况主要体现在无指征用药、疗程不合理、选药不合理、联合用药不合理、给药方法及剂量不合理、存在配伍禁忌、溶媒选用不当等方面.结论：该院门诊抗菌药物使用还存在一些问题,应加强监督管理,积极开展抗菌药物合理使用的培训,以提高抗菌药物合理应用水平.     

Prevalence and determinants of antibiotic resistance in faecal Escherichia coli among unselected patients attending general practitioners in Southwest Germany

PURPOSE: Widespread use of antibiotics is thought to be the main reason for the world-wide increase in antibiotic resistance. Although a great majority of antibiotics are prescribed outside hospitals, little is known about the prevalence and determinants of antibiotic resistance in the general population. METHODS: Escherichia coli (E. coli) was cultured from and minimal inhibitory concentrations against six commonly prescribed antibiotic substances were tested in 750 stool samples of 484 unselected, consecutive outpatients aged 40-74 years attending general practitioners. Odds ratios (OR) and their 95% confidence intervals (CI) for the association between potential risk factors and the prevalence of antibiotic resistance were estimated using generalised estimating equations. RESULTS: Prevalence of E. coli resistance against ampicillin, doxycycline, cotrimoxazole or quinolones was 24%. Current antibiotic use was strongly associated with antibiotic resistance, adjusted OR: 11.1, 95% CI: 2.3-53, but antibiotic resistance was unaffected by antibiotic use stopped weeks before. Recent hospitalisations were the only other significant predictor of an increased prevalence of resistance. CONCLUSIONS: The strong association between current use of antibiotics and colonisation with antibiotic resistant E. coli suggests a major role for selection of resistant strains while using antibiotics that seem to be quickly reversible, though.     

抗生素的合理使用与进展性研究

探讨抗生素在临床上的合理应用,通过调研、分析抗生素不合理使用的原因、表现及后果,发现临床上抗生素不合理使用及滥用的原因主要在于医生、患者追求经济效益等方面因素。其表现是没有明确的抗生素应用的适应证、无规律用药、不合理联合用药;不按照抗生素梯次选择药物的原则等。不合理使用抗生素导致后果：细菌对其产生广泛而迅速的耐药性、严重的二重感染和不良反应增加,药物资源的浪费和增加患者经济负担等,故只有加强医院临床抗生素的合理应用,才能使抗生素的应用更安全、有效、经济、合理。     

2012年厦门莲花医院门急诊抗菌药物应用合理性分析

目的：了解我院门急诊抗菌药物使用情况,并评价其使用合理性,为临床合理使用抗菌药物提供参考。方法：根据卫生部办公厅发出的《2011年全国抗菌药物临床应用专项整治活动方案》,每个月组织对25%具有抗菌药物处方权的医师所开具的处方中抗菌药物使用情况进行分析,并评价抗菌药物使用的合理性。每名医师抽查的处方不少于50张,不足50张的按实际开具处方数。结果：2012年共抽查门诊处方31 729张,其中抗菌药物处方6 870张,抗菌药物使用率为21.65%;使用抗菌药物不合理处方406张,占5.91%。急诊处方9 402张,其中抗菌药物处方2 483张,抗菌药物使用率为26.41%;使用抗菌药物不合理处方443张,占17.84%。结论：我院门急诊抗菌药物使用基本合理,但仍存在不合理用药情况,应进一步加强抗菌药物的管理,提高抗菌药物合理用药水平。     

Differences in biofilm formation and antimicrobial resistance of Pseudomonas aeruginosa isolated from airways of mechanically ventilated patients and cystic fibrosis patients

Pseudomonas aeruginosa biofilms exhibit increased antimicrobial resistance compared with planktonic isolates and are implicated in the pathogenesis of both acute and chronic lung infections. Whilst antibiotic choices for both infections are based on planktonic antibiotic susceptibility results, differences in biofilm-forming ability between the two diseases have not previously been explored. The aim of this study was to compare differences in biofilm formation and antibiotic resistance of P. aeruginosa isolated from intubated patients and from patients with chronic pulmonary disease associated with cystic fibrosis (CF). The temporal evolution of antibiotic resistance in clonal P. aeruginosa strains isolated from CF patients during periods of chronic infection and acute pulmonary exacerbation was also evaluated. Biofilm formation and biofilm antibiotic susceptibilities were determined using a modified microtitre plate assay and were compared with antibiotic susceptibility results obtained using traditional planktonic culture. Clonality was confirmed using random amplified polymorphic DNA polymerase chain reaction (RAPD-PCR) analysis. Pseudomonas aeruginosa isolates collected from intubated patients produced substantially more biofilms compared with CF isolates. There was considerable heterogeneity in biofilm-forming ability amongst the CF isolates and this was unrelated to pulmonary status. Biofilm antibiotic resistance developed rapidly amongst clonal CF isolates over time, whilst traditional antibiotic resistance determined using planktonic cultures remained stable. There was a significant positive correlation between imipenem/cilastatin and ceftazidime resistance and biofilm-forming ability. The variability in biofilm-forming ability in P. aeruginosa and the rapid evolution of biofilm resistance may require consideration when choosing antibiotic therapy for newly intubated patients and CF patients.