It is now widely recognized that inappropriate use of antibiotics is a major driver of the emergence and spread of antibiotic resistance. This has resulted in the development of antibiotic stewardship programmes, which aim to optimize antibiotic use by maximizing the clinical benefits while minimizing adverse consequences including toxicity and resistance. As antibiotic resistance is a global threat, the formulation of stewardship programmes and assessment of their cost-effectiveness requires knowledge of the trends in antibiotic usage at local, national and international levels. For many years, a major contribution to the surveillance of antibiotic use has been provided by the European Surveillance of Antimicrobial Consumption Network (ESAC-Net, formerly ESAC), which comprises an international network of surveillance systems that collects data on antibiotic consumption across the EU/European Economic Area (EEA). This Supplement comprises a series of articles presenting data on antibiotic consumption in the community from 30 EU/EEA countries over two decades (1997 to 2017), and updates previously available information covering the periods 1997–2003 and 1997–2009. The articles review temporal trends, seasonal variation, presence of change-points and changes in the composition of the main antibiotic groups. Data outputs are presented as yearly antibiotic consumption aggregated at the level of the active substance, using the WHO ATC classification and expressed in DDD (ATC/DDD index 2019) per 1000 inhabitants per day, analysed using a range of non-linear mixed models. For those readers not fully conversant with such statistical methodology, the Supplement also includes a tutorial that describes and illustrates statistical methods for analysing time trends (including abrupt changes, referred to as change-points) in antibiotic consumption. These updated analyses of two decades of ESAC-Net data provide the most comprehensive and detailed description yet of antibiotic consumption in the community in Europe, which we hope will be of interest to JAC readers, and in particular those involved in informing and evaluating control strategies.

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前言

现在人们普遍认识到，抗生素的不当使用是抗生素耐药性出现和传播的主要驱动因素。这导致了抗生素管理计划的发展，该计划旨在通过最大化临床益处同时最小化不良后果（包括毒性和耐药性）来优化抗生素的使用。由于抗生素耐药性是一个全球性威胁，制定管理计划和评估其成本效益需要了解当地、国家和国际层面的抗生素使用趋势。多年来，欧洲抗生素消费监测网络（ESAC-Net，前身为 ESAC）为抗生素使用监测做出了重大贡献，它由一个国际监测系统网络组成，该网络收集整个欧盟/欧洲经济区 (EEA) 的抗生素消费数据。本增刊包括一系列文章，介绍了 20 年（1997 年至 2017 年）来自 30 个欧盟/欧洲经济区国家的社区抗生素消费数据，并更新了涵盖 1997-2003 年和 1997-2009 年期间的现有信息。文章回顾了时间趋势、季节性变化、变化点的存在以及主要抗生素组的组成变化。数据输出表示为在活性物质层面汇总的年度抗生素消耗量，使用 WHO ATC 分类，并以每天每 1000 名居民的 DDD（ATC/DDD 指数 2019）表示，并使用一系列非线性混合模型进行分析。对于那些不完全熟悉这种统计方法的读者，本增刊还包括一个教程，该教程描述和说明了用于分析抗生素消费时间趋势（包括突然变化，称为变化点）的统计方法。这些对 20 年 ESAC-Net 数据的最新分析提供了迄今为止欧洲社区抗生素消费最全面、最详细的描述，我们希望 JAC 读者会感兴趣，尤其是那些参与告知和评估控制策略的读者.