国产日韩欧美一区二区三区三州_亚洲少妇熟女av_久久久久亚洲av国产精品_波多野结衣网站一区二区_亚洲欧美色片在线91_国产亚洲精品精品国产优播av_日本一区二区三区波多野结衣 _久久国产av不卡

?

全球抗菌藥物使用監(jiān)測現(xiàn)狀的循證評價

2018-07-13 02:09曾力楠張祚潔張伶俐黃亮歸舸
中國藥房 2018年2期
關(guān)鍵詞:抗菌藥物使用監(jiān)測

曾力楠 張祚潔 張伶俐 黃亮 歸舸

中圖分類號 R978.1;R969.3 文獻標(biāo)志碼 A 文章編號 1001-0408(2018)02-0145-07

DOI 10.6039/j.issn.1001-0408.2018.02.01

摘 要 目的:為我國抗菌藥物使用監(jiān)測工作的持續(xù)改進提供循證依據(jù)。方法:通過檢索Medline、Embase、Cochrane Library等3個生物醫(yī)學(xué)文獻數(shù)據(jù)庫和48個衛(wèi)生行政部門和學(xué)術(shù)機構(gòu)網(wǎng)站,搜集抗菌藥物使用監(jiān)測網(wǎng)/項目的相關(guān)文獻,提取其基本信息及數(shù)據(jù)采集、分析和報告方法等內(nèi)容,采用描述性分析方法,分析全球抗菌藥物使用監(jiān)測網(wǎng)/項目的現(xiàn)狀。結(jié)果:最終納入文獻21篇,共涉及抗菌藥物使用監(jiān)測網(wǎng)/項目16個,其中國際級3個、國家級13個,以歐洲(國家)為主(56.25%,9/16)。16個監(jiān)測網(wǎng)/項目均旨在監(jiān)測并比較抗菌藥物使用情況,分析抗菌藥物使用趨勢及其與細(xì)菌耐藥的相關(guān)性,評價抗菌藥物管理政策的實施效果。負(fù)責(zé)機構(gòu)以衛(wèi)生行政部門為主,資助機構(gòu)以政府相關(guān)部門為主。現(xiàn)有監(jiān)測網(wǎng)/項目以醫(yī)院和社區(qū)為主要監(jiān)測對象,針對兒童抗菌藥物使用的監(jiān)測網(wǎng)/項目有2個,包含兒童用藥數(shù)據(jù)的有6個,但僅有瑞典Strama單獨分析了兒童用藥數(shù)據(jù)。公布數(shù)據(jù)采集方法或內(nèi)容的監(jiān)測網(wǎng)/項目共14個,數(shù)據(jù)采集以主動上報為主,涉及藥品使用/消耗、人口/患者兩類數(shù)據(jù)。除ESAC-Net、ARPEC、NAUSP外,其余監(jiān)測網(wǎng)/項目均未提及數(shù)據(jù)校驗方法。數(shù)據(jù)分析以醫(yī)療機構(gòu)和抗菌藥物類別分類最為常見,限定日劑量是計算抗菌藥物消耗量最常用的統(tǒng)計指標(biāo)。公布監(jiān)測報告的監(jiān)測網(wǎng)/項目有10個,多以年報形式發(fā)布。結(jié)論:抗菌藥物使用監(jiān)測已在全球廣泛開展,但尚缺乏包括兒童在內(nèi)的特殊人群抗菌藥物使用監(jiān)測與分析;另外,數(shù)據(jù)校驗是抗菌藥物使用監(jiān)測的薄弱環(huán)節(jié),數(shù)據(jù)采集質(zhì)量仍有待進一步提高。

關(guān)鍵詞 抗菌藥物;使用;監(jiān)測;循證評價

ABSTRACT 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; data 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.

KEYWORDS Antibacterial; Use; Surveillance; Evidence-based evaluation

抗菌藥物耐藥指微生物對原本能夠有效治療其所致感染的抗微生物藥物產(chǎn)生抵抗[1]。隨著新的耐藥機制的出現(xiàn)和傳播,抗菌藥物的耐藥形勢日益嚴(yán)峻,導(dǎo)致每年全球相關(guān)衛(wèi)生保健支出高達(dá)15億美元[2]。世界衛(wèi)生組織(World Health Organization,WHO)總干事陳馮富珍女士指出,各國政府已認(rèn)識到抗菌藥物耐藥性上升已成為當(dāng)今最大的公共衛(wèi)生挑戰(zhàn)之一,而抗菌藥物濫用是導(dǎo)致其耐藥性出現(xiàn)和加劇的重要原因,因此呼吁各國加強抗菌藥物使用與耐藥監(jiān)測,促進藥物合理使用[3]。鑒于此,本課題組通過系統(tǒng)檢索全球抗菌藥物使用監(jiān)測網(wǎng)/項目,比較及分析其監(jiān)測目的、方法和內(nèi)容等,以期為我國抗菌藥物使用監(jiān)測工作的持續(xù)改進提供參考。

1 資料與方法

1.1 納入與排除標(biāo)準(zhǔn)

1.1.1 納入標(biāo)準(zhǔn) ①文獻內(nèi)容:涉及國際或國家級抗菌藥物使用監(jiān)測網(wǎng)/項目;②發(fā)布機構(gòu):衛(wèi)生行政部門、學(xué)術(shù)機構(gòu);③語言:中文或英文。

1.1.2 排除標(biāo)準(zhǔn) 已停止監(jiān)測工作的抗菌藥物使用監(jiān)測網(wǎng)/項目。

1.2 檢索策略

計算機檢索Medline、Embase、Cochrane Library等3個生物醫(yī)學(xué)文獻數(shù)據(jù)庫以及38個國家和地區(qū)的48個衛(wèi)生行政部門和學(xué)術(shù)機構(gòu)相關(guān)網(wǎng)站(檢索策略見表1),調(diào)查抗菌藥物使用監(jiān)測網(wǎng)/項目的現(xiàn)狀。數(shù)據(jù)庫檢索式為:(Antibiotic or Antimicrobial) and (Surveillance or Monitor*),檢索建庫開始至2016年3月的相關(guān)文獻。

1.3 數(shù)據(jù)提取與分析

制訂統(tǒng)一的資料提取表,以10%的文獻進行預(yù)試驗。內(nèi)容包括:1)抗菌藥物使用監(jiān)測網(wǎng)/項目的基本信息,含監(jiān)測網(wǎng)/項目的名稱、負(fù)責(zé)機構(gòu)、組建時間、組建背景與目的、組建過程、組織構(gòu)架和監(jiān)測對象;2)數(shù)據(jù)采集方法,含采集人員、頻率、內(nèi)容、方法及數(shù)據(jù)校驗方法等;3)數(shù)據(jù)分析方法,含分析人員、頻率、內(nèi)容及方法;4)數(shù)據(jù)報告方法,含報告名稱、機構(gòu)、頻率、內(nèi)容和形式;5)反饋與改進,含反饋與改進機制和監(jiān)測效果評估。采用描述性分析方法,分析全球抗菌藥物使用監(jiān)測網(wǎng)/項目的現(xiàn)狀。

2 結(jié)果

2.1 文獻檢索與篩選結(jié)果

通過檢索數(shù)據(jù)庫及衛(wèi)生行政部門、學(xué)術(shù)機構(gòu)網(wǎng)站,共獲得文獻5 428篇,經(jīng)篩選,最終納入文獻21篇[4-24]。文獻篩選流程及結(jié)果見圖1。

2.2 抗菌藥物使用監(jiān)測網(wǎng)/項目的基本情況

21篇文獻共涉及抗菌藥物使用監(jiān)測網(wǎng)/項目16個[4-24],其中國際級3個、國家級13個,以歐洲(國家)為主(56.2%,9/16),基本情況見表2。16個監(jiān)測網(wǎng)/項目的目的一致,旨在監(jiān)測并比較抗菌藥物使用情況,分析抗菌藥物使用趨勢及其與細(xì)菌耐藥的相關(guān)性,評價抗菌藥物管理政策的實施效果,為制訂相關(guān)指南提供參考。負(fù)責(zé)機構(gòu)以衛(wèi)生行政相關(guān)部門為主(56.2%,9/16),其次為科研機構(gòu)(25.0%,4/16)和高校(12.5%,2/16);資助機構(gòu)以政府相關(guān)部門為主(31.2%,5/16)。各監(jiān)測網(wǎng)/項目負(fù)責(zé)機構(gòu)均由多學(xué)科人員組成,主要包括藥師、醫(yī)師、統(tǒng)計學(xué)專家等。國際級監(jiān)測網(wǎng)/項目中,各參與國均派協(xié)調(diào)員參與項目協(xié)調(diào)和實施[4-7]?,F(xiàn)有監(jiān)測網(wǎng)/項目以醫(yī)院和社區(qū)為主要監(jiān)測對象,另各有1個監(jiān)測網(wǎng)/項目分別監(jiān)測了社區(qū)藥店和養(yǎng)老院;針對兒童抗菌藥物使用的監(jiān)測網(wǎng)/項目有2個(GARPEC[4]和ARPEC[6-7]),此外包含兒童用藥數(shù)據(jù)的監(jiān)測網(wǎng)/項目有6個[12-18,24]。

2.3 抗菌藥物使用監(jiān)測網(wǎng)/項目的數(shù)據(jù)采集及來源

2.3.1 數(shù)據(jù)采集 公布數(shù)據(jù)采集方法或內(nèi)容的監(jiān)測網(wǎng)/項目共14個,數(shù)據(jù)采集以主動上報為主。其中,歐洲ESAC-Net[5,22-23]、ARPEC[6-7]和加拿大CIPARS[9]在正式數(shù)據(jù)采集前先通過預(yù)調(diào)研評估數(shù)據(jù)方案。監(jiān)測內(nèi)容以抗菌藥物使用與消耗的現(xiàn)狀和趨勢為主,數(shù)據(jù)采集方式具體包括成員單位上報或數(shù)據(jù)庫采集,包含藥品使用/消耗、人口/患者兩類數(shù)據(jù),較少涉及使用合理性評價,詳見表3(表中,采集方法a表示成員單位向監(jiān)測網(wǎng)/項目上報數(shù)據(jù),b表示監(jiān)測網(wǎng)/項目從數(shù)據(jù)庫中提取數(shù)據(jù))。由于CARPEC缺乏相關(guān)數(shù)據(jù),故未列入該表中。其中,ESAC-Net[5,22-23]、ARPEC[6-7]等采集總體數(shù)據(jù),中國CAS[20]采集抽樣數(shù)據(jù),其余均未見報道。藥品數(shù)據(jù)來源于醫(yī)療機構(gòu)、衛(wèi)生行政部門、醫(yī)藥信息服務(wù)提供商和研究機構(gòu),其中醫(yī)療機構(gòu)是其主要來源。但在發(fā)達(dá)國家,某些醫(yī)藥市場研究公司因已擁有該國主要抗菌藥物使用數(shù)據(jù),故成為了監(jiān)測數(shù)據(jù)主要的來源機構(gòu)(如加拿大的艾美仕市場研究公司)。

2.3.2 數(shù)據(jù)校驗 數(shù)據(jù)校驗是抗菌藥物監(jiān)測的薄弱環(huán)節(jié),除ESAC-Net[5,22-23]、ARPEC[6-7]、NAUSP[19]外,其他監(jiān)測網(wǎng)/項目均未提及數(shù)據(jù)校驗方法。其中,ESAC-Net[5,22-23]采用系統(tǒng)校驗、國家間數(shù)據(jù)對比和專家校驗方式:①數(shù)據(jù)上報過程中內(nèi)置校驗程序;②數(shù)據(jù)匯總過程中對比各國數(shù)據(jù);③數(shù)據(jù)核對過程中由專業(yè)人員對比往年數(shù)據(jù),檢查離群值。ARPEC[6-7]通過系統(tǒng)內(nèi)置程序校驗,能在出現(xiàn)錯誤信息或不完整數(shù)值時阻止提取。NAUSP[19]將當(dāng)月數(shù)據(jù)與前一年均值進行比較,當(dāng)差異超過2個標(biāo)準(zhǔn)差時啟動數(shù)據(jù)核查程序。

2.3.3 數(shù)據(jù)分析 數(shù)據(jù)分析層次與監(jiān)測范圍、目的相關(guān),以醫(yī)療機構(gòu)和抗菌藥物類別分類最為常見;限定日劑量是計算抗菌藥物消耗量最常用的統(tǒng)計指標(biāo)[22],詳見表4[表中,“√”表示該監(jiān)測網(wǎng)/項目涉及此內(nèi)容;PPS為現(xiàn)患率調(diào)查,即研究特定時點或時期和特定范圍內(nèi)人群中的有關(guān)變量(因素)與疾病或健康狀況的關(guān)系;DIDs為每1 000名居民每日的限定日劑量數(shù),即限定日劑量總數(shù)×1 000/(居民數(shù)×天數(shù));DBDs為每100個床位每日的限定日劑量數(shù),即限定日劑量總數(shù)×100/(床位數(shù)×天數(shù));DADs為每100名住院患者的限定日劑量數(shù),即限定日劑量總數(shù)×100/住院患者數(shù);a為每1 000名居民每日的抗菌藥物包裝數(shù),即抗菌藥物包裝數(shù)×1 000/(居民數(shù)×天數(shù));b為單次住院使用抗菌藥物的天數(shù),即使用抗菌藥物的總天數(shù)/住院人次數(shù);c為每1 000張?zhí)幏絾卧南薅ㄈ談┝繑?shù),即限定日劑量總數(shù)×1 000/處方單元;d為每100名患者每日的限定日劑量數(shù),即限定日劑量總數(shù)×100/(患者數(shù)×天數(shù))]。由于CARPEC缺乏相關(guān)數(shù)據(jù),故未列入該表中。在特殊人群方面,盡管有6個監(jiān)測網(wǎng)/項目同時監(jiān)測了成人與兒童用藥數(shù)據(jù),但僅瑞典Strama[15-16]單獨分析了兒童用藥數(shù)據(jù)。

2.4 抗菌藥物使用監(jiān)測網(wǎng)/項目的監(jiān)測報告

公布監(jiān)測報告的監(jiān)測網(wǎng)/項目有10個,多以年報形式發(fā)布,僅澳大利亞NAUSP[19]、SAAUSP[21]每2月發(fā)布1次。歐洲ESAC-Net[5,22-23]和英國ESPAUR[12,24]有監(jiān)測報告計劃書。

3 討論

細(xì)菌耐藥已成為全球面臨的嚴(yán)重威脅。WHO在2011年提出“遏制耐藥——今天不采取行動,明天就無藥可用”[25]的倡議,并于2014年5月發(fā)布了《控制細(xì)菌耐藥全球行動計劃(草案)》[26],旨在督促各國制訂抗菌藥物行動計劃。該行動計劃的五個戰(zhàn)略目標(biāo)之一就是“優(yōu)化抗菌藥物使用”。而作為導(dǎo)致細(xì)菌耐藥的重要原因,抗菌藥物濫用日益受到各國重視。多國已建立了較為完善的抗菌藥物使用監(jiān)測機制,作為控制藥物濫用的重要手段。

本研究顯示,抗菌藥物使用監(jiān)測已在全球廣泛開展。其中,歐洲抗菌藥物使用監(jiān)測網(wǎng)/項目的數(shù)量最多(占56.2%),是目前抗菌藥物使用監(jiān)測方法學(xué)發(fā)展的前沿地區(qū),其抗菌藥物使用監(jiān)測及數(shù)據(jù)分析、報告的方法值得借鑒;衛(wèi)生行政部門是全球抗菌藥物監(jiān)測的主要負(fù)責(zé)機構(gòu),其監(jiān)測對象以社區(qū)和醫(yī)院為主;限定日劑量是全球普遍采用的計算抗菌藥物消耗量的統(tǒng)計指標(biāo)。盡管各地抗菌藥物監(jiān)測已廣泛開展,但仍存在以下不足:(1)數(shù)據(jù)校驗是保障數(shù)據(jù)質(zhì)量的重要步驟,但現(xiàn)有監(jiān)測網(wǎng)/項目數(shù)據(jù)校驗實施情況不明,不同監(jiān)測機構(gòu)的監(jiān)測數(shù)據(jù)質(zhì)量仍有差距;(2)針對特殊人群(如兒童)抗菌藥物使用的監(jiān)測尚未廣泛開展,現(xiàn)有方法用于特殊人群時仍存有局限性[27]。

基于全球抗菌藥物發(fā)展的現(xiàn)狀與趨勢,筆者對我國抗菌藥物使用監(jiān)測提出如下建議:(1)完善監(jiān)測網(wǎng)/項目專家組成員的學(xué)科構(gòu)成,應(yīng)包含感染學(xué)、藥學(xué)、統(tǒng)計學(xué)、信息學(xué)等專業(yè)人員;(2)建立數(shù)據(jù)采集預(yù)試驗機制,每年初公布經(jīng)預(yù)試驗后的抗菌藥物監(jiān)測數(shù)據(jù)采集方案,對各監(jiān)測點人員開展定期培訓(xùn),以提高數(shù)據(jù)采集質(zhì)量;(3)進一步開展對特殊人群抗菌藥物使用情況的監(jiān)測,如兒童、孕產(chǎn)婦、老年人、重癥監(jiān)護病房患者等,探索特殊人群抗菌藥物監(jiān)測的數(shù)據(jù)采集和分析方法;(4)定期公開發(fā)布抗菌藥物使用監(jiān)測數(shù)據(jù),并向各監(jiān)測點反饋監(jiān)測結(jié)果,以達(dá)到通過監(jiān)測來控制抗菌藥物濫用的目的。

[致謝:教育部長江學(xué)者創(chuàng)新團隊基金(No.IRT0935)、國際合理用藥網(wǎng)絡(luò)中國中心組高風(fēng)險用藥人群藥物管理組]

參考文獻

[ 1 ] World Health Organization. Antimicrobial drug resistance[EB/OL].[2016-10-25]. http://www.who.int/mediacentre/factsheets/fs194/zh/.

[ 2 ] World Health Organization. Antimicrobial resistance[EB/OL].[2016-10-25]. http://www.who.int/mediacentre/factsheets/antibiotic-resistance/en/.

[ 3 ] World Health Organization. WHO multi-country survey reveals widespread public misunderstanding about antibiotic resistance[EB/OL]. [2016-10-25]. http://www.who.int/mediacentre/news/releases/2015/antibiotic-resistance/en/.

[ 4 ] St Georges University of London. The Global Antimicrobial Resistance, Prescribing, and Efficacy among Neonates and Children (GARPEC)[EB/OL]. [2016-10-25]. http://garpec.org/.

[ 5 ] European Centre for Disease Prevention and Control. European Surveillance of Antimicrobial Consumption Network(ESAC-Net)[EB/OL]. [2016-10-25]. http://ecdc.europa.eu/en/activities/surveillance/ESAC-Net/Pages/index.aspx.

[ 6 ] VERSPORTEN A,BIELICKI J, DRAPIER N, et al. The Worldwide Antibiotic Resistance and Prescribing in European Children (ARPEC) point prevalence survey: developing hospital-quality indicators of antibiotic prescribing for children[J]. J Antimicrob Chemother,2016,71(4):1106-1117.

[ 7 ] VERSPORTEN A, SHARLAND M, BIELICKI J, et al. The antibiotic resistance and prescribing in European children project: a neonatal and pediatric antimicrobial web- based point prevalence survey in 73 hospitals worldwide[J]. Pediatr Infect Dis, 2013, 32(6):e242-e253.

[ 8 ] National Healthcare Safety Network (NHSN). Antimicrobial Use(AU)[EB/OL]. [2016-10-25]. http://www.cdc.gov/nhsn/acute-care-hospital/aur/index.html.

[ 9 ] Public Health Agency of Canada. Canadian Integrated Pr- ogram for Antimicrobial Resistance Surveillance (CIPARS)[EB/OL].[2016-10-25].http://www.phac-aspc.gc.ca/cipars- picra/index-eng.php.

[10] The Canadian Antimicrobial Resistance Alliance. The Canadian Antimicrobial Resistance Alliance(CARA)[EB/OL]. [2016-10-25]. http://www.can-r.com/index.php.

[11] National Food Institute, Technical University of Denmark National Veterinary Institute. The Danish Integrated Antimicrobial Resistance Monitoring and Research Programme(DANMAP)[EB/OL]. [2016-10-25]. http://www.danmap.org/.

[12] Public Health England. English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR)[EB/OL]. [2016-10-25]. http://www.dh.gov.uk/en/index.htm.

[13] The Scottish Government Health Department. Scottish Antimicrobial Prescribing Group (SAPG)[EB/OL]. [2016- 10-25].http://www.isdscotland.org/Health-Topics/Prescri- bing-and-Medicines/SAPG/.

[14] Public Health Wales. Welsh Antimicrobial Resistance Programme (WARP)[EB/OL]. [2016-10-25]. http://www.wales.nhs.uk/sites3/page.cfm?orgid=457&pid=28418.

[15] Swedish Institute for Infectious Disease Control. Swedish strategic programme against antibiotic resistance(Strama)[EB/OL]. [2016-10-25]. http://en.strama.se.

[16] M?LSTAD S, ERNTELL M, HANBERGER H, et al. Sustained reduction of antibiotic use and low bacterial resistance: ten-year follow-up of the Swedish Strama programme[J]. Lancet Infect Dis, 2008, 8(2):125-132.

[17] Dutch Foundation of the Working Party on Antibiotic Policy. Consumption of antimicrobial agents and antimicrobial resistance among medically important bacteria in The Netherlands (NethMap)[EB/OL]. [2016-10-25]. http://www.swab.nl/swab/cms3.nsf/viewdoc/hom-01?opendocument.

[18] Surveillance of Antimicrobial Use and Antimicrobial Resistance in Intensive Care Units(SARI)[EB/OL]. [2016- 10-25]. http://sari.eu-burden.info.

[19] Infection Control Service,Communicable Disease Control Branch, SA Health. National Antimicrobial Utilisation Surveillance Program(NAUSP)[EB/OL]. [2016-10-25].https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+programs/antimicrobial+stewardship/national+antimicrobial+utilisation+surveillance+program+nausp.

[20] 國家衛(wèi)生計生委. 全國抗菌藥物臨床應(yīng)用監(jiān)測網(wǎng)[EB/OL]. [2016-10-25]. http://y.chinadtc.org/program/index.php.

[21] World Health Organization. WHO Collaborating Centre for Drug Statistics methodology[EB/OL]. [2016-10-25]. https://www.whocc.no/atc_ddd_index/.

[22] European Centre for Disease Prevention and Control European. Surveillance report(2012) surveillance of antimicrobial consumption in Europe:2014[EB/OL]. [2016-12- 01]. https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/antimicrobial-consumption-europe-e- sac-net-2012.pdf .

[23] European Centre for Disease Prevention and Control (ECDC). Antimicrobial consumption (AMC) reporting protocol 2015: European Surveillance of Antimicrobial Consumption Network(ESAC-Net):2015[EB/OL]. [2016- 12-01]. https://ecdc.europa.eu/en/healthtopics/antimicrobial-resistance-and-consumption/antimicrobial-consumption/ publications-documents/Documents/https%3A//portal2.ecdc- net.europa.eu/sites/portal/files/media/en/healthtopics/antimic- robial-resistance-and-consumption/antimicrobial-consumption/publications-documents/Documents/antimicrobial-consu- mption-reporting-protocol.pdf.

[24] Public Health England. Antimicrobial consumption data: validation protocol for NHS acute trust[EB/OL].(2015- 03-25) [2016-12-01]. https://www.gov.uk/government/publications/antimicrobial-consumption-data-validation-pr- otocol-for-nhs-acute-trusts.

[25] World Health Organization. World health day:7 April 2011[EB/OL].[2016-10-25]. http://www.who.int/world-health- day/2011/en/.

[26] World Health Organization. Draft global action plan on antimicrobial resistance[S]. 2014-05-08.

[27] 張伶俐,李幼平,曾力楠,等. 用兒童藥物利用指數(shù)評價兒科用藥劑量合理性的思考與探索[J].中國循證醫(yī)學(xué)雜志, 2012, 12(2):125-128.

(收稿日期:2017-02-28 修回日期:2017-11-08)

(編輯:張元媛)

猜你喜歡
抗菌藥物使用監(jiān)測
氣囊測壓表在腹內(nèi)壓監(jiān)測中的應(yīng)用
基于 WSN 的隧道健康監(jiān)測研究
高層建筑沉降監(jiān)測數(shù)據(jù)處理中多元回歸分析方法的應(yīng)用研究
高層建筑沉降監(jiān)測數(shù)據(jù)處理中多元回歸分析方法的應(yīng)用研究
微量激素聯(lián)合抗菌藥物治療細(xì)菌性角膜炎的療效觀察
淺談普通高校竹笛專業(yè)教材的使用
淺談工位器具的合理性設(shè)計與使用
論中職德育課教學(xué)中案例的選擇與使用
淺談如何提高導(dǎo)學(xué)案在初中數(shù)學(xué)教學(xué)中的實效性
學(xué)習(xí)監(jiān)測手環(huán)