Abstract

Objectives

Surveillance of antibiotic consumption in the community is of utmost importance to inform and evaluate control strategies. Data on two decades of antibiotic consumption in the community were collected from 30 EU/European Economic Area (EEA) countries. This article reviews temporal trends and the presence of abrupt changes in subgroups of relevance in antimicrobial stewardship.

Methods

For the period 1997–2017, data on yearly antibiotic consumption in the community, aggregated at the level of the active substance, were collected using the WHO ATC classification and expressed in DDD (ATC/DDD index 2019) per 1000 inhabitants per day. We applied a range of non-linear mixed models to assess the presence of changes in the consumption of antibacterials for systemic use (ATC group J01) and eight antibiotic subgroups.

Results

For the majority of the studied groups, a country-specific change-point model provided the best fit. Depending on the antibiotic group/subgroup and on the country, change-points were spread out between 2000 and 2013.

Conclusions

Due to the heterogeneity in antibiotic consumption in the community across EU/EEA countries, a country-specific change-point model provided the better fit. Given the limitations of this model, our recommendation for the included countries is to carefully interpret the country-specific results presented in this article and to use the tutorial included in this series to conduct their own change-point analysis when evaluating the impact of changes in regulations, public awareness campaigns, and other national interventions to improve antibiotic consumption in the community.

中文翻译：

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欧盟/欧洲经济区社区抗生素消费变化点，1997-2017 年

摘要

目标

社区抗生素消费监测对于告知和评估控制策略至关重要。社区二十年来抗生素消费的数据是从 30 个欧盟/欧洲经济区 (EEA) 国家收集的。本文回顾了抗菌药物管理相关亚组的时间趋势和突然变化的存在。

方法

1997-2017 年期间，使用 WHO ATC 分类收集社区每年抗生素消耗量数据（按活性物质水平汇总），并以每 1000 名居民每天的 DDD（ATC/DDD 指数 2019）表示。我们应用了一系列非线性混合模型来评估全身使用的抗菌药物（ATC J01 组）和八个抗生素亚组的消耗量是否存在变化。

结果

对于大多数研究群体来说，特定国家/地区的变化点模型提供了最合适的选择。根据抗生素组/亚组和国家的不同，变化点分布在 2000 年至 2013 年之间。

结论

由于欧盟/欧洲经济区国家社区抗生素消费的异质性，特定国家的变化点模型提供了更好的拟合。考虑到该模型的局限性，我们对所包含国家的建议是仔细解释本文中提出的特定于国家的结果，并在评估变化的影响时使用本系列中包含的教程来进行自己的变化点分析。法规、公众意识运动和其他国家干预措施，以改善社区抗生素的消费。