Significant reduction of ammonia emissions while increasing crop yields using the 4R nutrient stewardship in an intensive cropping system

Ammonia (NH_3) emissions should be mitigated to improve environmental quality.Croplands are one of the largest NH_3sources,they must be managed properly to reduce their emissions while achieving the target yields.Herein,we report the NH_3 emissions,crop yield and changes in soil fertility in a long-term trial with various fertilization regimes,to explore whether NH_3 emissions can be significantly reduced using the 4R nutrient stewardship (4Rs),and its interaction with the organic amendments (i.e.,manure and straw) in a wheat–maize rotation.Implementing the 4Rs significantly reduced NH_3 emissions to 6 kg N ha~(–1) yr~(–1) and the emission factor to 1.72%,without compromising grain yield (12.37 Mg ha~(–1) yr~(–1))and soil fertility (soil organic carbon of 7.58 g kg~(–1)) compared to the conventional chemical N management.When using the 4R plus manure,NH_3 emissions (7 kg N ha~(–1) yr~(–1)) and the emission factor (1.74%) were as low as 4Rs,and grain yield and soil organic carbon increased to 14.79 Mg ha~(–1) yr~(–1) and 10.09 g kg~(–1),respectively.Partial manure substitution not only significantly reduced NH_3 emissions but also increased crop yields and improved soil fertility,compared to conventional chemical N management.Straw return exerted a minor effect on NH_3 emissions.These results highlight that 4R plus manure,which couples nitrogen and carbon management can help achieve both high yields and low environmental costs.

Knowledge, Attitudes, and Practices of Poultry Farmers on Antimicrobial Use and Resistance in Kitwe, Zambia: Implications on Antimicrobial Stewardship

Introduction: The inappropriate antimicrobial usage (AMU) in chicken production has led to an increase in the prevalence of antimicrobial resistance (AMR). In Zambia, there is little information documented regarding the knowledge, attitude, and practices of poultry farmers on AMU and AMR. Therefore, this study assessed the knowledge, attitude and practices regarding AMU and AMR among poultry farmers in Kitwe, Zambia. Methods: This was a cross-sectional study conducted among 106 poultry farmers from November to December 2021 using a structured questionnaire. Data analysis was done using IBM Statistical Package for Social Sciences (SPSS) version 26. Results: Overall, of the 106 participants, 90.6% knew what antimicrobials were, but only 29.2% were aware of AMR. The study showed that 46.2% of the participants had low knowledge, 71.7% had negative attitudes, and 61.3% had poor practices regarding AMR. The prevalence of antibiotic use in poultry production was 83%. The most used antimicrobials were tetracycline (84%) and gentamicin (35.2%). The commonly reported reason for the use of antimicrobials was for the treatment (93.2%) and prevention (89.8%) of diseases. Further, 76.9% of the administered antimicrobials were usually done without veterinarian consultation or prescription. Conclusion: The study shows that there was high AMU in poultry farms in Kitwe. However, there was low knowledge, negative attitude, and poor practices towards AMU and AMR. Therefore, there is a need for educational and sensitisation programmes regarding AMU and AMR among poultry farmers in Kitwe, Zambia. Alongside this, antimicrobial stewardship and surveillance systems should be strengthened in the livestock production sector. This will ensure food safety and public health.

Antimicrobial Stewardship: Knowledge and Attitudes of Pharmacy Staff on Antibiotic Dispensing Patterns, Use and Resistance in Benin

Background: One of the key drivers for the emergence and spread of antimicrobial resistance (AMR) is non-prudent antibiotic use, which results in selection pressure toward relevant bacteria. Pharmacy staffs have pivotal roles in facilitating the prudent use of antibiotics through antimicrobial stewardship programs. Due to limited information in Benin, this study assessed the knowledge and attitudes of pharmacy staffs on antibiotic use and resistance. Materials and Methods: This cross-sectional study was conducted among 159 pharmacy staffs using a structured questionnaire from August 2018 to December 2018 in Benin. Data analysis was done by using Stata version 13.0. Results: Of the 159 participants, 54.8% knew the definition of antibiotic therapy and 66.9% knew the definition of probabilistic antibiotic therapy. The majority (88.1%) of the participants thought that the choice of antibiotics was made according to the pathology, while 60.4% thought that it depended on the pathology and the germ involved. 49.02% of dispensers in pharmacies stated that half of the patients had requested treatment without providing a prescription at the pharmacy. The top three antibiotics that were dispensed without a prescription include amoxicillin (98.1%), cloxacillin (76.7%) and metronidazole (57.2%), all from the Access group of antibiotics. Conclusion: These results underscore the need for educational and training interventions targeting specific professional groups. There is an urgent need for regulatory measures and public awareness through improved antimicrobial stewardship to limit this practice.

Towards an Antimicrobial Stewardship Program in a Young Tertiary Hospital in Southern Nigeria: A Point Prevalence Survey of Antimicrobial Usage

Background: Antimicrobial resistance (AMR) is one of the top 10 global public health threats facing humanity and this burden is borne largely by low and middle-income countries. As part of efforts to combat AMR, the World Health Organization has identified Antimicrobial Stewardship as one of the strategic objectives of its global action plan on antimicrobial resistance. This survey aimed to observe antimicrobial prescribing and usage patterns in the Rivers State University Teaching Hospital with the purpose of identifying gaps to inform the specific antimicrobial stewardship interventions necessary to address our specific needs. Methodology: A point prevalence survey was conducted using the protocol and web-based automated data management system designed by the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance, University of Antwerp, Belgium, in November 2021. Results: A total of 69 adult medical and surgical patients were surveyed;27 males and 18 females. Antimicrobial prevalence was 65.2%. Third generation cephalosporins (24.4%;33.3%), fluoroquinolones (17.8%;22.2%) and imidazole derivatives (20%;36.1%) were most prescribed on the medical and surgical wards. Antimicrobial guidelines were completely unavailable, most antimicrobials (93.8%) were prescribed empirically and 64.4% of these remained empirical after 72 hours of commencement. Conclusion: Antimicrobial stewardship interventions are necessary to minimize sub-optimal antimicrobial prescribing practices in our facility. Most critical are education on appropriate use of antimicrobials, support for development of antimicrobial guidelines, diagnostic stewardship, and the drive for improved use of the laboratory to guide antimicrobial prescriptions. The antimicrobial stewardship committee and team must drive this, having the requisite support from the management and prescribers, with the primary outcomes being reduced antimicrobial prevalence and improved antimicrobial prescription patterns.

Impact of Antimicrobial Stewardship Programs on Antibiotic Use and Drug Resistance:Analysis of Data from Maternal and Child Health Care Hospitals in Hubei Province,China

ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hospitals(maternal and child health care hospitals)in Hubei province from 2012 to 2019 were collected.The indicators related to antimicrobial drug use included the utilization rate of different grades of antimicrobial drugs,the intensity of antimicrobial agent use,the rational use of prophylactic antimicrobial agents before class I surgical incision,and pathogenic detection and consultation rates before antimicrobial drug use.ResultsSince the implementation,the purchase of antimicrobial agents in hospitals has been maintained within the prescribed range,and the defined daily dose system(DDDs)of antimicrobial agents has been reduced,prophylactic use and accurate treatment of antimicrobial agents related to class I surgical incision have been more reasonable.With the implementation of ASPs,the detection rate of imipenem-resistant Acinetobacter baumannii,cefotaxime-resistant Escherichia coli,and methicillin-resistant Staphylococcus aureus has been decreased in China from national bacterial resistance surveillance data.ConclusionASPs have positive effects on antibiotic use and drug resistance in 85 maternity hospitals(maternal and child health care hospitals).

Antibiotic stewardship programmes in intensive care units:Why,how,and where are they leading us

Antibiotic usage and increasing antimicrobial resistance(AMR) mount significant challenges to patient safety and management of the critically ill on intensive care units(ICU). Antibiotic stewardship programmes(ASPs) aim to optimise appropriate antibiotic treatment whilst minimising antibiotic resistance. Different models of ASP in intensive care setting, include "standard" control of antibiotic prescribing such as "de-escalation strategies"through to interventional approaches utilising biomarkerguided antibiotic prescribing. A systematic review of outcomes related studies for ASPs in an ICU setting was conducted. Forty three studies were identified from MEDLINE between 1996 and 2014. Of 34 nonprotocolised studies, [1 randomised control trial(RCT), 22 observational and 11 case series], 29(85%) were positive with respect to one or more outcome: These were the key outcome of reduced antibiotic use, or ICU length of stay, antibiotic resistance, or prescribing cost burden. Limitations of non-standard antibiotic initiation triggers, patient and antibiotic selection bias or baseline demographic variance were identified. All 9 protocolised studies were RCTs, of which 8 were procalcitonin(PCT) guided antibiotic stop/start interventions. Five studies addressed antibiotic escalation, 3 de-escalation and 1 addressed both. Six studies reported positive outcomes for reduced antibiotic use, ICU length of stay or antibiotic resistance. PCT based ASPs are effective as antibiotic-stop(de-escalation) triggers, but not as an escalation trigger alone. PCT has also been effective in reducing antibiotic usage without worsening morbidity or mortality in ventilator associated pulmonary infection. No study has demonstrated survival benefit of ASP. Ongoing challenges to infectious disease management, reported by the World Health Organisation global report 2014, are high AMR to newer antibiotics, and regional knowledge gaps in AMR surveillance. Improved AMR surveillance data, identifying core aspects of successful ASPs that are transferable, and further well-conducted trials will be necessary if ASPs are to be an effective platform for delivering desired patient outcomes and safety through best antibiotic policy.

Effective Antibiotic Stewardship Program: Controlling Antibiotic Resistance and Optimizing Drug Use in Ahmadi Hospital

An Antimicrobial Stewardship Program (ASP) is established to promote cost effective and safe use of antimicrobial agents. Basically, this approach directs the management of antimicrobials in terms of selection of appropriate drugs, determination of administration routes and standardization of both medication dosage and treatment duration. The program involves, but is not limited to, Hospital Staff Education, Pharmacodynamics Dose Optimization, Computer-Assisted Decision Support Programs, Pharmacist-Driven Intravenous to Oral Switch Programs, Pharmacy Dosing Programs and Antibiotic Cycling. A study was conducted to determine effectiveness of the ASP in significantly improving patient outcomes (e.g. decrease morbidity and mortality from infection). This was undertaken by collecting restrospective data on patient length of hospital stay, bed turnover rate and antibiotic consumption over a period of 2 years since the ASP was initiated. Periodic data were then compared and interpreted based on its clinical, quality and financial implications in order to measure effectiveness of the program implementation.

Perceptions of Beach Stewards and Information Needs for Shorebird Stopover Sites Vary as a Function of Visitor Interests: Improving Stewardship Programs in Coastal Landscapes

Many studies have demonstrated that some of the activities of people can disturb nesting and foraging birds, particularly along coasts and estuaries. Some managers respond to human disturbance of sensitive species by closing beaches, but most have stewards monitor and restrict access to beaches or portions of beaches. Yet little is known about the type of visitor or their perceptions of beach stewards. This paper explores the general acceptance of beach stewards and their role in conservation of red knots (Calidris canutus rufa), other shorebirds, and horseshoe crabs (Limulus polyphemus) along the Delaware Bay (New Jersey) beaches by interviewing 279 visitors during the stopover period. While most people came to see the shorebird and horseshoe crab spectacle (60%), many came for the scenery, tranquility, and recreation. Just over half of the people interviewed said that the stewards were helpful (58%), although most of those that answered this question later said that they provided conservation value (86%), but only 40% said they relied on the stewards for information. On a Likert rating scale of 1 to 5 (the highest value), the mean rating for whether it was important for stewards to be present was 3.87 ± 0.09, and the rating for the presence of stewards who can provide information was 3.71 ± 0.11. In contrast, protection of shorebirds was rated a mean of 4.79 ± 0.04. There were significant visitor type differences in how important stewards were, but not in the importance of stewards who can provide information. Fishermen, recreationists, and people coming for scenery and tranquility rated the presence of stewards higher than those visitors who were interested in either shorebirds or crabs (or both). Ratings also differed significantly as a function of age and gender;older adults and females rated characteristics higher than did people under 30 years and males. Information needs identified by stewards are also discussed. These data can be used by the managers developing a strategy for conservation of shorebirds and other species sensitive to disturbance, and for the implementation of an effective stewardship program.

Standards and Regulatory Stewardship Workshop

How govemment think about regulation in the 21st century is changing. This workshop as the first session of Pacific Area Standards Congress 2019 will bring together standardizers and regulators to Look at how standards can play a part in regulatory stewardship, an innovative and proactive approach for government regulatory agencies.

Impact of an Antimicrobial Stewardship Program Initiative on Antibiotic Optimization in Patients with Gram-Negative Bacteremia

The purpose of this study was to critically evaluate the impact of an institutional blood culture notification protocol called RAIDS （rapid administration of antimicrobials by an infectious diseases specialist） on time to optimization of antimicrobial therapy in hospitalized patients with gram-negative bacteremia. Time to antibiotic optimization was compared in patients with gram-negative bacilli isolated from blood cultures obtained from March-May 2011 （pre-RAIDS） versus March-May 2013 （post-RAIDS）. The results show that patients in the pre-RAIDS study group had a significantly longer time to antibiotic optimization when compared to the post-RAIDS group （median （IQR）, 27.6 （10.8-75.8） h vs. 3.1 （0.8-34.3） h, p = 0.03）. The RAIDS protocol resulted in quicker time to antibiotic de-escalation （pre- vs. post-RAIDS; median （IQR）, 27.6 （10.8-134.5） h vs. 4.3 （1.4-32.6） h, p = 0.03）. There were no differences in clinical outcomes such as clinical cure, microbiological cure, and 30-day mortality between pre-RAIDS and post-RAIDS study groups. Patients in the post-RAIDS arm were more likely to receive appropriate empiric and definitive treatment. Implementation of the RAIDS protocol, which was an ASP （antimicrobial stewardship program） initiative, resulted in quicker time to antibiotic de-escalation and overall treatment optimization. RAIDS reduced the unnecessary use of broad-spectrum antimicrobial in this study population.

The Practice of Pharmacist-Driven Antimicrobial Stewardship Based on Value-Based Healthcare

Objective To evaluate the effect of pharmacist-driven antimicrobial stewardship based on value-based healthcare in a tertiary hospital in China.Methods The application of plan-do-check-action(PDCA)cycle and antimicrobial stewardship(AMS)were respectively used to improve the rational use of antimicrobial agents in prophylactic and therapeutic.Data were collected and the effect was assessed during the management period(2016-2019).Results and Conclusion From 2016(before implementation)to 2019(after implementation),the rational use of antibiotics were obviously enhanced in outpatients,inpatients,and emergency department.For instance,the utilization rate in type I incision operation was decreased from 26.42%to 14.60%(P=0.000),the daily doses of antibiotic per 100 patient-days decreased from 49.34±2.97 to 35.89±4.96(P=0.000),and the average antibiotic expenditures dropped from 948.53 yuan to 526.30 yuan(P=0.000).There was no significant change in infection rate,nosocomial mortality rate,and the length of hospital stay.After the implementation of clinical pharmacist-driven antimicrobial stewardship based on value-based healthcare,the consumption and cost of antibacterial have been greatly reduced.Therefore,the pharmacist-driven antimicrobial stewardship increases its value。

Antimicrobial stewardship and targeted therapies in the changing landscape of maternal sepsis

Pregnant and postnatal women are a high-risk population particularly prone to rapid progression to sepsis with significant morbidity and mortality worldwide.Moreover,severe maternal infections can have a serious detrimental impact on neonates with almost 1 million neonatal deaths annually attributed to maternal infection or sepsis.In this review we discuss the susceptibility of pregnant women and their specific physiological and immunological adaptations that contribute to their vulnerability to sepsis,the implications for the neonate,as well as the issues with antimicrobial stewardship and the challenges this poses when attempting to reach a balance between clinical care and urgent treatment.Finally,we review advancements in the development of pregnancy-specific diagnostic and therapeutic approaches and how these can be used to optimize the care of pregnant women and neonates.

Antimicrobial stewardship in the intensive care unit

High resistance rates to antimicrobials continue to be a global health threat.The incidence of multidrug-resistant(MDR)microorganisms in intensive care units(ICUs)is quite high compared to in the community and other unitsin the hospital because ICU patients are generally older,have higher numbers of co-morbidities and immunesuppressed;moreover,the typically high rates of invasive procedures performed in the ICU increase the risk ofinfection by MDR microorganisms.Antimicrobial stewardship(AMS)refers to the implementation of coordinatedinterventions to improve and track the appropriate use of antibiotics while offering the best possible antibioticprescription(according to dose,duration,and route of administration).Broad-spectrum antibiotics are frequentlypreferred in ICUs because of greater infection severity and colonization and infection by MDR microorganisms.For this reason,a number of studies on AMS in ICUs have increased in recent years.Reducing the use of broadspectrum antibiotics forms the basis of AMS.For this purpose,parameters such as establishing an AMS team,limiting the use of broad-spectrum antimicrobials,terminating treatments early,using early warning systems,pursuing infection control,and providing education and feedback are used.In this review,current AMS practicesin ICUs are discussed.

感染预防控制与抗菌药物管理协同降低细菌耐药水平的临床实践

目的探讨医疗机构应用感染预防控制(IPC)与抗菌药物管理(AMS)的协同模式降低细菌耐药水平的效果。方法收集某院2015年1月1日—2022年12月31日所有住院患者医院感染管理、抗菌药物相关指标及多重耐药菌(MDRO)检出率,评估IPC联合AMS协同模式的效果。结果与2015—2016年比较,2021—2022年MDRO医院感染发病率从0.22%下降至0.16%(P<0.05),住院患者抗菌药物使用强度从48.48下降至42.17,抗菌药物使用率从49.45%下降至45.21%(P<0.05);Ⅰ类切口手术预防性抗菌药物使用率从48.62%下降至33.13%(P<0.05);与2017—2018年比较,2021—2022年抗菌药物治疗前病原学送检率从60.73%上升至72.18%(P<0.05)。与2015—2016年比较,2021—2022年除耐万古霉素粪肠球菌检出率略有上升,其余各类常见MDRO检出率均下降,尤其是耐甲氧西林金黄色葡萄球菌、耐碳青霉烯类鲍曼不动杆菌、耐碳青霉烯类铜绿假单胞菌、产广谱β-内酰胺酶肺炎克雷伯菌、产广谱β-内酰胺酶大肠埃希菌、耐氟喹诺酮类大肠埃希菌,差异均有统计学意义(均P<0.05)。结论采取IPC与AMS的协同模式,可有效促进抗菌药物合理使用,减少MDRO的产生和传播,降低细菌耐药。

最新综述执行摘要:终末期患者抗菌药物的使用

对于仍然坚定致力于提供以患者为中心的医疗服务,并同时参与共同决策促进抗菌药物管理的感染性疾病(ID)医生来说,在患者终末期如何使用抗菌药物是一项挑战。在住院和门诊环境中为难治性或复发性感染患者提供连续治疗的感染性疾病医生可以在患者生命特别脆弱的时刻提供周到的、精准的指导。

Portraying Diabetic Foot Ulcers: Comparative Evaluation of Diabetic Foot Infections versus Diabetic Foot Ulcers

Background: Confusion often arises in caring for diabetic foot infections and ulcers, especially with antimicrobials;we aim to shed light on this entity and alert healthcare workers to its stewardship. Methods: Records were reviewed between February 2016 and September 2023. Data for patients diagnosed with diabetes and foot ulcers, infected or not, were examined following ICD 9 search terms. Records for patients were included if they were prediabetic/diabetic adults with foot ulcers, more than 18 years old, and on antidiabetic treatment. Patients were excluded if they insulin resistant, with normal HgbA1c levels, wheel-chair dependent, bed-bound, non-diabetic patients, diabetic patients who had vascular lower limb surgery earlier to ulcers, diabetic patients who had aortocoronary bypass, deep venous thrombosis within six months, malignancy, and severe clinical depression. A modified IWGDF/IDSA guidelines definitions for DFI and DFU was considered. Statistical analysis was done using R programming. Statistical methods were employed as appropriate, and a significant P-value was considered for P Results: Most characteristics were well balanced between DFI and DFU, on imaging osteomyelitis and tissue swelling were significantly more in DFI. Endovascular radiological procedures showed angiograms to be considerably more in DFI, while angioplasty was more in DFU, in addition to smoking. Bacteremia was uncommon, and swab cultures were mostly polymicrobial in both ulcers;no clear association with blood bacteria was detected with the polymicrobial growth, though few were concordant. Antimicrobials prescribed for both ulcers were not statistically different except for carbapenems, which were more in DFI (P Conclusion: Attention should be paid to best practices while caring for diabetic ulcers. These include swab culture interpretations, the use of antimicrobials, and plan management according to DFI or DFU to utilize either local care or combination with antimicrobials.

Global Burden of Fungal Infections and Antifungal Resistance from 1961 to 2024: Findings and Future Implications

Background: Antifungal resistance (AFR) is a global public health problem with devastating effects, especially among immunocompromised individuals. Addressing AFR requires a One Health approach including Antifungal Stewardship (AFS). This study aimed to comprehensively review global studies published on fungal infections and AFR and to recommend solutions to address this growing problem. Materials and Methods: This was a narrative review that was conducted using published papers on fungal infections, AFR, and AFS between January 1961 and March 2024. The literature was searched using PubMed, Google Scholar, Web of Science, and EMBASE. Results: This found that there has been an increase in fungal infections globally, especially among immunocompromised patients. Due to this increase in fungal infections, there has been a proportionate increase in the use of antifungal agents to prevent and treat fungal infections. This increased use of antifungal agents has worsened the problem of AFR contributing to increased morbidity and mortality. Globally, fungal infections have contributed to 150 million infections annually and 1.7 million deaths per year. By the year 2023, over 3.8 million people died from fungal infections. Addressing AFR remains a challenge because the treatment of antifungal-resistant infections is difficult. Finally, the treatment of fungal infections is a global challenge exacerbated by the limited number of antifungal agents to treat invasive fungal infections. Conclusion: The results of this study indicated that fungal infections and AFR are prevalent across humans, animals, agriculture, and the environment. Addressing this problem requires the provision of solutions such as improving the awareness of AFR, conducting further research on the discovery of new antifungal agents, and implementing AFS programs. If this global problem is not addressed, the morbidity and mortality associated with AFR will continue to rise in the future.

多学科协作模式在医院抗菌药物管理中的应用

目的探索多学科协作(MDT)模式在医院抗菌药物管理中的应用效果。方法采用回顾性分析方法收集某院2021年1月—2022年12月住院患者使用抗菌药物的相关资料,2021年1—12月采取常规管理模式(对照组),2022年1—12月采取MDT管理模式(干预组)。比较两组患者抗菌药物治疗相关指标。结果采取MDT管理模式后,干预组治疗性抗菌药物使用前病原学送检率(73.62%)高于对照组(70.56%),差异有统计学意义(P<0.001)。医院感染诊断相关病原学送检率对照组为87.98%,干预组为88.89%,两组比较差异无统计学意义(P>0.05)。干预组重点药物联合使用前病原学送检率(93.94%)高于对照组(92.00%),差异有统计学意义(P<0.05)。住院患者抗菌药物使用率和Ⅰ类切口手术预防性抗菌药物使用率下降,分别由原来的38.03%、21.03%下降至32.78%、10.30%,差异均具有统计学意义(均P<0.05)。干预组住院患者的抗菌药物使用量和使用强度均下降。干预后多重耐药菌(MDRO)集束化防控措施落实率均较对照组提高,差异有统计学意义(均P<0.05)。MDRO检出率由34.70%下降至32.37%,差异有统计学意义(P=0.027),MDRO例次感染率无明显变化。结论MDT管理模式可以有效提高抗菌药物的规范化管理,促进临床合理使用抗菌药物,防止细菌耐药。

基于WOS数据库药师参与抗菌药物管理的文献计量和可视化分析

目的:对国内外药师参与抗菌药物管理的文献进行文献计量和可视化分析,旨在揭示该领域研究热点,并为未来开展相关研究提供参考。方法:检索Web of Science数据库建库至2023年10月13日,搜索关键词“pharmacist”“antimicrobial stewardship”“antibiotic stewardship program”“antimicrobial resistance”和“infection”等。使用CiteSpace和VOSviewer软件检测引文突现,绘制关键词共现图谱,使用文献计量学方法分析年发文量、发文国家、作者和机构等,分析药师参与抗菌药物管理的研究现状和热点。结果:共检索到2991篇英文文献,发文量最多的国家为美国和英国。研究热点主要集中在抗菌药物管理、抗菌药物耐药性、感染、药师、指南、干预和结局等主题。结论:药师(特别是专职抗感染药师和社区药师)参与抗菌药物管理以遏制细菌耐药可能是未来研究的热点和趋势,这将有助于提高临床的抗菌药物处方合理性,减少抗菌药物费用的支出、不良反应的发生以及细菌耐药性的发生。