COVID-19 大流行对德国住院病人抗生素和抗真菌药物处方量的影响

Winfried V. Kern, Michaela Steib-Bauert, Jürgen Baumann, Evelyn Kramme, Gesche Först, Katja de With
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摘要

背景:以前的研究发现,2019 年冠状病毒病(COVID-19)大流行对人类医学中抗菌药物的消耗量产生了不同程度的影响,在几个欧洲国家,社区处方和住院处方的趋势各不相同。目的:本研究分析了 2019 年至 2022 年期间德国急诊医院抗菌药和抗真菌药配药量和使用密度的变化。研究方法使用推荐的医院适应性日剂量定义(RDDs)和(作为敏感性分析)WHO/ATC定义的日剂量定义(DDD),以每年日剂量总量或使用密度(每100名患者/占用床日的日剂量)表示279家医院四年来的监测数据,并进行描述性分析。根据医院规模(床位数)、所属大学和地理位置(东部、西部、南部)对医院进行了分层。结果与 2019 年相比,2020 年至 2022 年的患者总天数和抗菌药物用量均有明显下降。2019 年与 2020 年、2021 年和 2022 年之间的相对变化分别为:患者天数-12.8%、-13.5% 和-13.3%,抗菌药物 RDD-9.7%、-11.0% 和-10.1%。广谱β内酰胺类药物,特别是哌拉西林-他唑巴坦和碳青霉烯类药物的用量有所增加,这与其他大多数药物类别不同。由此产生的抗菌药物使用密度略有增加,但幅度较大,2019 年的合计平均值(和中位数)为 43.3 (40.0) RDD/100,而 2020 年至 2022 年的合计平均值(和中位数)分别为 44.8 (41.7)、44.5 (40.80) 和 44.9 (41.7) RDD/100。抗真菌药物的用量和使用密度在 2019 年后有所增加,并在 2021 年达到峰值(2019 年和 2021 年的总用量差值分别为 +6.4%,总平均使用密度差值为 +22.9%)。这些趋势在不同医院分层中相似,在使用 DDD 而不是 RDD 时也具有可比性。结论:与在大多数欧洲国家观察到的情况类似,德国急症医院的抗菌药物使用总量随着大流行而减少,但在 2022 年没有出现反弹现象。不过,由于医院能力有限,而且可能有更多免疫力低下的普通内科病人,住院病人开具的(主要是广谱)抗菌药和抗真菌药处方有所增加。
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Impact of the COVID-19 Pandemic on Inpatient Antibiotic and Antifungal Drug Prescribing Volumes in Germany
Background: Previous studies found that the coronavirus disease 2019 (COVID-19) pandemic had a variable impact on the consumption of antimicrobial drugs in human medicine, with trends in several European countries differing between community and inpatient prescribing. Aim: This study analysed changes in the volumes and use density of antibacterial and antifungal drugs dispensed in acute care hospitals in Germany between 2019 and 2022. Methods: Surveillance data for the four years available from 279 hospitals were expressed as the total volumes of daily doses or as use density (daily doses per 100 patient/occupied bed days) per year and analysed descriptively, using recommended hospital-adapted daily dose definitions (RDDs) and (as sensitivity analysis) WHO/ATC-defined daily dose definitions (DDD). Hospitals were stratified according to size (number of beds), university affiliation, and location (East, West, South). Results: There were significant decreases in both the total number of patient days and antibacterial drug volumes in 2020 through 2022 compared with 2019. The relative changes between 2019 and 2020, 2021, and 2022 were −12.8%, −13.5%, and −13.3% for patient days, and −9.7%, −11.0%, and −10.1% for antibacterial RDDs, respectively. Broad-spectrum betalactams, notably piperacillin–tazobactam and carbapenems, increased in volume, unlike most other drug classes. The resulting antibacterial drug use density was slightly but significantly increased, with pooled means (and medians) of 43.3 (40.0) RDD/100 in 2019 compared to 44.8 (41.7), 44.5 (40.80), and 44.9 (41.7) RDD/100 in the years 2020 through 2022, respectively. Antifungal drug volumes and use density increased after 2019 and peaked in 2021 (the difference between 2019 and 2021 for total volumes was +6.4%, and that for pooled mean use density values was +22.9%, respectively). These trends were similar in the different hospital strata and comparable when DDDs instead of RDDs were used. Conclusions: Similar to what has been observed in a majority of European countries, the total volume of antibacterial drug use in German acute care hospitals decreased with the pandemic, without a rebound phenomenon in 2022. In association with restricted hospital capacities and presumably more immunocompromised general medicine patients, however, inpatient prescribing of (primarily broad-spectrum) antibacterials and of antifungal drugs increased.
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