Abstract：
BACKGROUND: Antimicrobial stewardship programs are a critical tool for addressing the rising threat of antimicrobial resistance.
OBJECTIVE: To determine changes in patterns of antimicrobial use in Queensland public hospitals following introduction of the National Safety and Quality Health Service antimicrobial stewardship standard.
METHODS: A retrospective pre/post intervention study was conducted across Queensland public hospitals at the ecological level using Queensland Health\'s MedTRx database. An interrupted time series analysis was performed using linear regression models to determine rates of antimicrobial use by quarterly aggregated defined daily dose per 1000 patient days, for groups of hospitals stratified by peer group classification. Pre-defined time periods for antimicrobial stewardship program implementation in response to the introduction of the standard were analysed.
RESULTS: In the post intervention period, there was a decrease in overall use of systemic antimicrobials, glycopeptides, carbapenems and fluoroquinolones in principal referral and public acute group A hospitals. A decrease in overall use was also observed for smaller regional and remote public acute group C and D hospitals, however, increases in glycopeptide and fluoroquinolone use were observed. Third generation cephalosporin use was unchanged for all hospital peer groups. The proportion of overall use that was accounted for by narrow spectrum penicillin was low for all facilities, with modest improvements in the post intervention period observed in principal referral facilities only.
CONCLUSIONS: These findings add to current knowledge on the effectiveness of legislative quality standards on antimicrobial stewardship at the macro level and highlight gaps to target for future programs.
OBJECTIVE: To determine changes in patterns of antimicrobial use in Queensland public hospitals following introduction of the National Safety and Quality Health Service antimicrobial stewardship standard.
METHODS: A retrospective pre/post intervention study was conducted across Queensland public hospitals at the ecological level using Queensland Health\'s MedTRx database. An interrupted time series analysis was performed using linear regression models to determine rates of antimicrobial use by quarterly aggregated defined daily dose per 1000 patient days, for groups of hospitals stratified by peer group classification. Pre-defined time periods for antimicrobial stewardship program implementation in response to the introduction of the standard were analysed.
RESULTS: In the post intervention period, there was a decrease in overall use of systemic antimicrobials, glycopeptides, carbapenems and fluoroquinolones in principal referral and public acute group A hospitals. A decrease in overall use was also observed for smaller regional and remote public acute group C and D hospitals, however, increases in glycopeptide and fluoroquinolone use were observed. Third generation cephalosporin use was unchanged for all hospital peer groups. The proportion of overall use that was accounted for by narrow spectrum penicillin was low for all facilities, with modest improvements in the post intervention period observed in principal referral facilities only.
CONCLUSIONS: These findings add to current knowledge on the effectiveness of legislative quality standards on antimicrobial stewardship at the macro level and highlight gaps to target for future programs.
摘要：
背景：抗菌药物管理计划是应对日益增长的抗菌药物耐药性威胁的关键工具。
目的：确定在引入国家安全和质量卫生服务抗菌药物管理标准后，昆士兰州公立医院抗菌药物使用模式的变化。
方法：使用昆士兰卫生部的MedTRx数据库，在生态层面对昆士兰公立医院进行了回顾性干预前/后研究。使用线性回归模型进行中断的时间序列分析，以按季度汇总的每1000名患者每日定义的每日剂量确定抗菌药物使用率。对于按同行群体分类分层的医院群体。分析了针对标准引入的抗菌药物管理计划实施的预定义时间段。
结果：在干预后期间，全身抗菌药物的整体使用有所减少，糖肽，主要转诊和公共急性A组医院的碳青霉烯类和氟喹诺酮类药物。较小的区域和偏远的公共急症C组和D组医院的总体使用量也有所下降，然而,观察到糖肽和氟喹诺酮的使用增加。对于所有医院同行组，第三代头孢菌素的使用没有变化。在所有设施中，窄谱青霉素在总体使用中所占的比例较低，仅在主要转诊设施中观察到干预后期间略有改善。
结论：这些发现在宏观层面增加了关于抗菌药物管理立法质量标准有效性的现有知识，并突出了未来计划目标的差距。
目的：确定在引入国家安全和质量卫生服务抗菌药物管理标准后，昆士兰州公立医院抗菌药物使用模式的变化。
方法：使用昆士兰卫生部的MedTRx数据库，在生态层面对昆士兰公立医院进行了回顾性干预前/后研究。使用线性回归模型进行中断的时间序列分析，以按季度汇总的每1000名患者每日定义的每日剂量确定抗菌药物使用率。对于按同行群体分类分层的医院群体。分析了针对标准引入的抗菌药物管理计划实施的预定义时间段。
结果：在干预后期间，全身抗菌药物的整体使用有所减少，糖肽，主要转诊和公共急性A组医院的碳青霉烯类和氟喹诺酮类药物。较小的区域和偏远的公共急症C组和D组医院的总体使用量也有所下降，然而,观察到糖肽和氟喹诺酮的使用增加。对于所有医院同行组，第三代头孢菌素的使用没有变化。在所有设施中，窄谱青霉素在总体使用中所占的比例较低，仅在主要转诊设施中观察到干预后期间略有改善。
结论：这些发现在宏观层面增加了关于抗菌药物管理立法质量标准有效性的现有知识，并突出了未来计划目标的差距。
