Investigating the WHO's AWaRe classification for assessing antimicrobial stewardship programs: A single-center study

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES Journal of Infection and Chemotherapy Pub Date : 2025-01-01 DOI:10.1016/j.jiac.2024.08.025

Kazutaka Oda , Shinichiro Okamoto , Eisaku Iwanaga , Hirotomo Nakata

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Abstract

Background

AWaRe (Access, Watch, Reserve) classification proposed by the World Health Organization (WHO) holds potential for assessing antimicrobial stewardship programs (ASPs). However, increase in antibiotics for non-infectious treatment might undermine the effectiveness of using the AWaRe classification for assessing ASPs. The study aimed to evaluate the antimicrobial usage by AWaRe classification and specify issues for assessing ASPs.

Methods

The retrospective study was conducted in a single center within an 845-bed hospital. Antimicrobial usage data for outpatients were obtained from medical records used for billing purposes. Antimicrobials for non-infectious treatment were defined by smaller dose of macrolides, tetracyclines with pemphigoid, rifaximin, and prophylactic sulfamethoxazole-trimethoprim (ST) agent.

Results

The usage of antimicrobials for non-infectious treatment increased from 25.3 % to 50.1 % for the ratio of the amount to defined daily doses (DDDs) and from 46.3 % to 65.9 % for prescription days between January 2015 and March 2024. The usage of prophylactic sulfamethoxazole-trimethoprim (ST) agents increased by 2.4 times, and the usage of rifaximin increased by more than 100 times. Macrolides for non-infectious treatment was stable or fluctuated while that for infection treatment decreased to that amount for non-infectious treatment. The ratios for Access increased from 31.9 % to 58 % and 42 % to 78 % by excluding the antimicrobials for non-infectious treatment.

Conclusions

The findings suggested that the AWaRe classification might not be appropriate for assessing ASPs and comparing them among hospitals.

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调查世界卫生组织用于评估抗菌药物管理计划的 AWaRe 分类：单中心研究。

背景：世界卫生组织（WHO）提出的AWaRe（使用、观察、储备）分类法可用于评估抗菌药物管理计划（ASP）。然而，用于非感染性治疗的抗生素的增加可能会削弱使用 AWaRe 分类评估 ASP 的有效性。本研究旨在根据 AWaRe 分类评估抗菌药物的使用情况，并明确评估 ASP 的问题：这项回顾性研究在一家拥有 845 张病床的医院内的一个中心进行。门诊患者的抗菌药物使用数据来自用于结算的医疗记录。用于非感染性治疗的抗菌药物是指剂量较小的大环内酯类、四环素类、利福昔明和预防性磺胺甲噁唑-三甲双嘧啶（ST）制剂：在 2015 年 1 月至 2024 年 3 月期间，非感染性治疗抗菌药物的使用率从 25.3% 增加到 50.1%，处方天数从 46.3% 增加到 65.9%。预防性磺胺甲噁唑-三甲氧苄啶（ST）制剂的使用量增加了 2.4 倍，利福昔明的使用量增加了 100 多倍。用于非感染治疗的大环内酯类药物保持稳定或有所波动，而用于感染治疗的大环内酯类药物用量与非感染治疗用量相同。排除用于非感染治疗的抗菌药物后，获得率从 31.9%增至 58%，从 42%增至 78%：研究结果表明，AWaRe 分类法可能并不适合用于评估和比较各家医院的 ASPs。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Infection and Chemotherapy INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY

CiteScore

4.10

自引率

4.50%

发文量

303

审稿时长

47 days

期刊介绍： The Journal of Infection and Chemotherapy (JIC) — official journal of the Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases — welcomes original papers, laboratory or clinical, as well as case reports, notes, committee reports, surveillance and guidelines from all parts of the world on all aspects of chemotherapy, covering the pathogenesis, diagnosis, treatment, and control of infection, including treatment with anticancer drugs. Experimental studies on animal models and pharmacokinetics, and reports on epidemiology and clinical trials are particularly welcome.