美国疾病控制和预防中心Shelley S. Magill团队研究了2017年美国疗养院队列中的抗菌药物使用情况。2021年4月6日，《美国医学会杂志》发表了这一成果。

控制卫生保健中的抗菌药物耐药性是公共卫生的优先事项，但美国疗养院中抗菌药物使用的数据有限。

为了了解疗养院住院医师抗菌药物使用率，描述抗菌药物种类及常见适应症，2017年4月至2017年10月，研究组在10个新兴感染计划（EIP）州选定县的161个随机选择的疗养院中进行了一项抗菌药物使用的横断面、1天点流行率调查分析，共包括15276名居民。

EIP的工作人员查阅养老院的记录，收集调查时住户的特征和使用的抗菌药物数据。从疗养院工作人员和疗养院比较网站获得疗养院特征。主要观察指标为每100名居民抗菌药物使用率，定义为调查时接受抗菌药物治疗的居民人数除以被调查居民总数。并对抗菌药物使用和药物分类百分比进行分析。

15276名疗养院居民的平均年龄为77.6岁，其中62%为女性，96.8%的人有完整病历。总体抗菌药物使用率为8.2例/100居民。抗菌药物的使用在调查日前30天内入住疗养院（18.8例/100居民）、使用中心静脉导管（62.8例/100居民）或留置导尿管（19.1例/100居民）的居民中更为普遍。抗菌药物最常用于治疗活动性感染（77%），且主要用于尿路感染（28.1%）。18.2%的抗菌药物用于预防，最常用于泌尿道（40.8%）。氟喹诺酮类是最常见的抗菌药物（12.9%），33.1%的抗菌药物是广谱抗生素。

总之，2017年对美国疗养院队列进行的横断面调查结果表明，抗菌药物使用率为8.2例/100居民。

附：英文原文

Title: Antimicrobial Use in a Cohort of US Nursing Homes, 2017

Author: Nicola D. Thompson, Nimalie D. Stone, Cedric J. Brown, Austin R. Penna, Taniece R. Eure, Wendy M. Bamberg, Grant R. Barney, Devra Barter, Paula Clogher, Malini B. DeSilva, Ghinwa Dumyati, Linda Frank, Christina B. Felsen, Deborah Godine, Lourdes Irizarry, Marion A. Kainer, Linda Li, Ruth Lynfield, J. P. Mahoehney, Meghan Maloney, Joelle Nadle, Valerie L. S. Ocampo, Rebecca Pierce, Susan M. Ray, Sarah Shrum Davis, Marla Sievers, Krithika Srinivasan, Lucy E. Wilson, Alexia Y. Zhang, Shelley S. Magill

Issue&Volume: 2021/04/06

Abstract:

Importance  Controlling antimicrobial resistance in health care is a public health priority, although data describing antimicrobial use in US nursing homes are limited.

Objective  To measure the prevalence of antimicrobial use and describe antimicrobial classes and common indications among nursing home residents.

Design, Setting, and Participants  Cross-sectional, 1-day point-prevalence surveys of antimicrobial use performed between April 2017 and October 2017, last survey date October 31, 2017, and including 15276 residents present on the survey date in 161 randomly selected nursing homes from selected counties of 10 Emerging Infections Program (EIP) states. EIP staff reviewed nursing home records to collect data on characteristics of residents and antimicrobials administered at the time of the survey. Nursing home characteristics were obtained from nursing home staff and the Nursing Home Compare website.

Exposures  Residence in one of the participating nursing homes at the time of the survey.

Main Outcomes and Measures  Prevalence of antimicrobial use per 100 residents, defined as the number of residents receiving antimicrobial drugs at the time of the survey divided by the total number of surveyed residents. Multivariable logistic regression modeling of antimicrobial use and percentages of drugs within various classifications.

Results  Among 15276 nursing home residents included in the study (mean [SD] age, 77.6 [13.7] years; 9475 [62%] women), complete prevalence data were available for 96.8%. The overall antimicrobial use prevalence was 8.2 per 100 residents (95% CI, 7.8-8.8). Antimicrobial use was more prevalent in residents admitted to the nursing home within 30 days before the survey date (18.8 per 100 residents; 95% CI, 17.4-20.3), with central venous catheters (62.8 per 100 residents; 95% CI, 56.9-68.3) or with indwelling urinary catheters (19.1 per 100 residents; 95% CI, 16.4-22.0). Antimicrobials were most often used to treat active infections (77% [95% CI, 74.8%-79.2%]) and primarily for urinary tract infections (28.1% [95% CI, 15.5%-30.7%]). While 18.2% (95% CI, 16.1%-20.1%) were for medical prophylaxis, most often use was for the urinary tract (40.8% [95% CI, 34.8%-47.1%]). Fluoroquinolones were the most common antimicrobial class (12.9% [95% CI, 11.3%-14.8%]), and 33.1% (95% CI, 30.7%-35.6%) of antimicrobials used were broad-spectrum antibiotics.

Conclusions and Relevance  In this cross-sectional survey of a cohort of US nursing homes in 2017, prevalence of antimicrobial use was 8.2 per 100 residents. This study provides information on the patterns of antimicrobial use among these nursing home residents.

DOI: 10.1001/jama.2021.2900

Source: https://jamanetwork.com/journals/jama/article-abstract/2778111