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Antimicrobial use among adult inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program: 2009 to 2016.
Antimicrobial Resistance & Infection Control ( IF 5.5 ) Pub Date : 2020-02-13 , DOI: 10.1186/s13756-020-0684-2
Wallis Rudnick 1 , Michelle Science 2 , Daniel J G Thirion 3, 4 , Kahina Abdesselam 1 , Kelly B Choi 1 , Linda Pelude 1 , Kanchana Amaratunga 1, 5 , Jeannette L Comeau 6, 7 , Bruce Dalton 8 , Johan Delport 9 , Rita Dhami 9, 10, 11 , Joanne Embree 12, 13, 14 , Yannick Émond 15 , Gerald Evans 16 , Charles Frenette 4 , Susan Fryters 17 , Greg German 18 , Jennifer M Grant 19 , Jennifer Happe 20 , Kevin Katz 21 , Pamela Kibsey 22 , Justin Kosar 23 , Joanne M Langley 6, 7 , Bonita E Lee 24, 25 , Marie-Astrid Lefebvre 4 , Jerome A Leis 26 , Allison McGeer 27, 28, 29 , Heather L Neville 30 , Andrew Simor 28, 31 , Kathryn Slayter 6 , Kathryn N Suh 5 , Alena Tse-Chang 24, 25 , Karl Weiss 32 , John Conly 8, 33 ,
Affiliation  

BACKGROUND Antimicrobial resistance is a growing threat to the world's ability to prevent and treat infections. Links between quantitative antibiotic use and the emergence of bacterial resistance are well documented. This study presents benchmark antimicrobial use (AMU) rates for inpatient adult populations in acute-care hospitals across Canada. METHODS In this retrospective surveillance study, acute-care adult hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) submitted annual AMU data on all systemic antimicrobials from 2009 to 2016. Information specific to intensive care units (ICUs) and non-ICU wards were available for 2014-2016. Data were analyzed using defined daily doses (DDD) per 1000 patient days (DDD/1000pd). RESULTS Between 2009 and 2016, 16-18 CNISP adult hospitals participated each year and provided their AMU data (22 hospitals participated in ≥1 year of surveillance; 11 in all years). From 2009 to 2016, there was a significant reduction in use (12%) (from 654 to 573 DDD/1000pd, p = 0.03). Fluoroquinolones accounted for the majority of this decrease (47% reduction in combined oral and intravenous use, from 129 to 68 DDD/1000pd, p < 0.002). The top five antimicrobials used in 2016 were cefazolin (78 DDD/1000pd), piperacillin-tazobactam (53 DDD/1000pd), ceftriaxone (49 DDD/1000pd), vancomycin (combined oral and intravenous use was 44 DDD/1000pd; 7% of vancomycin use was oral), and ciprofloxacin (combined oral and intravenous use: 42 DDD/1000pd). Among the top 10 antimicrobials used in 2016, ciprofloxacin and metronidazole use decreased significantly between 2009 and 2016 by 46% (p = 0.002) and 26% (p = 0.002) respectively. Ceftriaxone (85% increase, p = 0.0008) and oral amoxicillin-clavulanate (140% increase, p < 0.0001) use increased significantly but contributed only a small component (8.6 and 5.0%, respectively) of overall use. CONCLUSIONS This study represents the largest collection of dispensed antimicrobial use data among inpatients in Canada to date. Between 2009 and 2016, there was a significant 12% decrease in AMU, driven primarily by a 47% decrease in fluoroquinolone use. Modest absolute increases in parenteral ceftriaxone and oral amoxicillin-clavulanate use were noted but contributed a small amount of total AMU. Ongoing national surveillance is crucial for establishing benchmarks and antimicrobial stewardship guidelines.

中文翻译:

加拿大医院感染监测计划内医院现场的成年住院患者使用抗菌药物:2009年至2016年。

背景技术抗菌素耐药性对世界预防和治疗感染的能力构成越来越大的威胁。定量使用抗生素与细菌耐药性出现之间的联系已得到充分证明。这项研究提出了加拿大急诊医院住院成年人口的基准抗菌药物使用率。方法在这项回顾性监测研究中,参加加拿大医院感染监测计划(CNISP)的急诊成人医院提交了2009年至2016年有关所有全身性抗生素的年度AMU数据。特定于重症监护病房(ICU)和非ICU病房的信息适用于2014-2016年。使用每1000个患者日的规定每日剂量(DDD)(DDD / 1000pd)分析数据。结果2009年至2016年,每年有16-18家CNISP成人医院参加,并提供了其AMU数据(有22家医院参加了≥1年的监测;共有11家医院在所有年中)。从2009年到2016年,使用量显着减少(12%)(从654 DDD / 1000pd减少到573 DDD,p = 0.03)。氟喹诺酮类药物是造成这种下降的主要原因(口服和静脉联合使用下降47%,从129 DDD / 1000pd降至68 DDD / 1000pd,p <0.002)。2016年使用的前五种抗菌药物是头孢唑林(78 DDD / 1000pd),哌拉西林-他唑巴坦(53 DDD / 1000pd),头孢曲松钠(49 DDD / 1000pd),万古霉素(口服和静脉联合使用为44 DDD / 1000pd; 7%口服万古霉素)和环丙沙星(口服和静脉联合使用:42 DDD / 1000pd)。在2016年使用的十大抗菌药物中,在2009年至2016年期间,环丙沙星和甲硝唑的使用量分别显着减少了46%(p = 0.002)和26%(p = 0.002)。头孢曲松(增加85%,p = 0.0008)和口服阿莫西林-克拉维酸盐(增加140%,p <0.0001)使用量显着增加,但仅占总使用量的一小部分(分别为8.6和5.0%)。结论本研究代表了迄今为止加拿大住院患者中分配的抗菌药物使用数据的最大集合。在2009年至2016年之间,主要由于氟喹诺酮使用量减少47%导致AMU显着下降12%。注意到肠胃外头孢曲松和口服阿莫西林-克拉维酸盐的使用量的绝对绝对增加,但贡献了少量的总AMU。
更新日期:2020-04-22
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