全球抗菌药物使用监测现状的循证评价

Evidence-based Evaluation on the Current Status of Global Antibacterial Use Surveillance

目的:为我国抗菌药物使用监测工作的持续改进提供循证依据。方法:通过检索Medline、Embase、Cochrane Library等3个生物医学文献数据库和48个卫生行政部门和学术机构网站,搜集抗菌药物使用监测网/项目的相关文献,提取其基本信息及数据采集、分析和报告方法等内容,采用描述性分析方法,分析全球抗菌药物使用监测网/项目的现状。结果:最终纳入文献21篇,共涉及抗菌药物使用监测网/项目16个,其中国际级3个、国家级13个,以欧洲(国家)为主(56.25%,9/16)。16个监测网/项目均旨在监测并比较抗菌药物使用情况,分析抗菌药物使用趋势及其与细菌耐药的相关性,评价抗菌药物管理政策的实施效果。负责机构以卫生行政部门为主,资助机构以政府相关部门为主。现有监测网/项目以医院和社区为主要监测对象,针对儿童抗菌药物使用的监测网/项目有2个,包含儿童用药数据的有6个,但仅有瑞典Strama单独分析了儿童用药数据。公布数据采集方法或内容的监测网/项目共14个,数据采集以主动上报为主,涉及药品使用/消耗、人口/患者两类数据。除ESAC-Net、ARPEC、NAUSP外,其余监测网/项目均未提及数据校验方法。数据分析以医疗机构和抗菌药物类别分类最为常见,限定日剂量是计算抗菌药物消耗量最常用的统计指标。公布监测报告的监测网/项目有10个,多以年报形式发布。结论:抗菌药物使用监测已在全球广泛开展,但尚缺乏包括儿童在内的特殊人群抗菌药物使用监测与分析;另外,数据校验是抗菌药物使用监测的薄弱环节,数据采集质量仍有待进一步提高。

OBJECTIVE： To provide evidence-based basis for the continuous improvement of antibacterial use surveillance in China. METHODS： Retrieving from 3 biomedical literature databases as Medline, Embase, Cochrane Library, 48 health administrative departments and academic institutions, relevant literatures on antibacterial surveillance networks/ projects were acquired and extracted, including basic information, data collection, analysis and reporting methods, etc. Descriptive analysis method was adopted to analyze the status quo of global antibacterial surveillance networks/projects. RESULTS： A total of 21 literatures were included, involving 16 antibacterial surveillance networks/projects. Among them, there were 3 international projects and 13 national projects, mainly in European （countries） （56.25% , 9/16）. Sixteen antibacterial surveillance networks/projects were established to monitor and compare the use of antibacterials, analyze the antibacterial use trend and its correlation with bacterial resistance, and evaluate implementation effect of antibacterial management policy. The responsible agencies were mainly the health administrative departments, and the funding agencies were mainly related government departments. Hospital and community were main surveillance objects. There were 2 surveillance networks/projects for antibacterial use in children, and 6 surveillance networks/projects contained medication data of children. Only Strama in Sweden alone analyzed medication data in children. Fourteen surveillance networks/projects promulgated data collection methods or contents; aata collection was mainly based on active reporting and involved the data of drug use/consumption and population/ patient. Except for ESAC-Net, ARPEC, NAUSP, data validation method was not mentioned in other surveillance networks/projects. Data analysis was most common in medical institutions and antibacterial categories, and defined daily dose was the most commonly used statistical indicators of antibacterial consumption. Ten surveillance networks/projects promulgated surveillance reports which were mostly published annually. CONCLUSIONS： Antibacterial surveillance have been widely operated worldwide. But there is a lack of monitoring and analysis of antibacterial use in special population including children. In addition, data validation is the weak link of antibacterial surveillance, so the quality of data collection still need to be improved.