Shirye-shiryen Kula da Magunguna na Antimicrobial (ASPs) sun zama ginshiƙi mai mahimmanci don inganta amfani da maganin rigakafi, inganta kulawar marasa lafiya, da kuma rage juriya na rigakafi (AMR).
Mun tsara nazarin dubawa na baya-bayan nan da kuma auna abubuwan da ke faruwa a cikin amfani da ƙwayoyin cuta da AMR kafin da kuma bayan aiwatar da ASP a cikin tsawon shekaru 4 (watanni 24 kafin da kuma watanni 24 bayan aiwatar da ASP) ta amfani da bincike-bincike na lokaci-lokaci.
Ana aiwatar da ASPs ne bisa albarkatun da kowace cibiya ke da su. Kafin aiwatar da ASP, an sami yanayin ƙara yawan amfani da ƙwayoyin cuta don duk matakan da aka zaɓa na maganin ƙwayoyin cuta. Bayan haka, an sami raguwar yawan amfani da ƙwayoyin cuta. Asibitoci, yayin da ceftriaxone, cefepime, piperacillin/tazobactam, meropenem, da vancomycin sun ragu a cikin rukunin kulawa mai zurfi.Tsarin karuwa a cikin Staphylococcus aureus mai jure oxacillin, Escherichia coli mai jure ceftriaxone, da meropenem mai jure Pseudomonas aeruginosa bayan aiwatar da Aeruginosa. .
A cikin bincikenmu, mun nuna cewa ASP wata hanya ce mai mahimmanci don magance barazanar AMR da ke fitowa kuma yana tasiri sosai ga raguwar ƙwayoyin cuta da juriya.
Antimicrobial Juriya (AMR) ana la'akari da barazanar duniya ga lafiyar jama'a [1, 2], yana haifar da mutuwar fiye da 700,000 a kowace shekara. A shekara ta 2050, adadin mutuwar zai iya kaiwa miliyan 10 a kowace shekara [3] kuma zai iya lalata babban Samfurin cikin gida na ƙasashe, musamman ƙasashe masu ƙanƙanta da matsakaicin kuɗi (LMICs) [4].
Babban daidaitawar ƙwayoyin cuta da alaƙar da ke tsakanin rashin amfani da ƙwayoyin cuta da AMR an san su shekaru da yawa [5] A cikin 1996, McGowan da Gerding sun yi kira ga "masu kula da amfani da ƙwayoyin cuta," gami da haɓaka zaɓin rigakafin ƙwayoyin cuta, kashi, da lokacin jiyya, don magancewa. barazanar da ke fitowa na AMR [6] A cikin 'yan shekarun da suka gabata, shirye-shiryen kula da ƙwayoyin cuta (ASPs) sun zama ginshiƙi na asali don inganta amfani da ƙwayoyin cuta ta hanyar inganta bin ka'idodin maganin ƙwayoyin cuta kuma an san su don inganta kulawar haƙuri yayin da suke da tasiri mai kyau akan AMR. [7, 8].
Ƙasashe masu ƙanƙanta da matsakaitan kuɗi yawanci suna da babban abin da ya faru na AMR saboda rashin saurin gwaje-gwajen bincike, magungunan rigakafi na ƙarni na ƙarshe, da sa ido kan cututtukan cututtuka [9], don haka dabarun ASP kamar horar da kan layi, shirye-shiryen jagoranci, jagororin ƙasa. , da kuma amfani da dandamali na kafofin watsa labarun ya zama fifiko [8]. manufofin kiwon lafiyar jama'a don magance AMR [9].
Yawancin binciken asibiti na marasa lafiya na asibiti sun nuna cewa ASP na iya inganta bin ka'idodin maganin maganin rigakafi da kuma rage yawan amfani da kwayoyin cutar da ba dole ba, yayin da yake da tasiri mai kyau akan ƙimar AMR, cututtuka na asibiti, da sakamakon haƙuri [8, 10, 11], 12. Abubuwan da suka fi dacewa sun haɗa da bita mai yiwuwa da amsawa, izini na farko, da kuma shawarwarin magani na musamman [13] Ko da yake an buga nasarar ASP a Latin Amurka, akwai 'yan rahotanni game da asibiti, microbiological, da tasirin tattalin arziki na waɗannan ayyukan. [14,15,16,17,18].
Manufar wannan binciken shine don kimanta tasirin ASP akan amfani da ƙwayoyin cuta da kuma AMR a cikin manyan asibitoci huɗu masu rikitarwa a Colombia ta amfani da binciken jerin lokaci mai katsewa.
Wani binciken lura da baya-bayan nan na gidaje hudu a cikin biranen Colombia guda biyu (Cali da Barranquilla) a cikin watanni 48 daga 2009 zuwa 2012 (watanni 24 kafin da watanni 24 bayan aiwatar da ASP) An yi a cikin asibitoci masu rikitarwa (cibiyoyin AD) .Antibiotic cinyewa da kuma meropenem-resistant Acinetobacter baumannii (MEM-R Aba), ceftriaxone-resistant E. coli (CRO-R Eco), ertapenem-resistant Klebsiella pneumoniae (ETP-R Kpn), abin da ya faru na Ropenem Pseudomonas aeruginosa (MEM-R Pae) da kuma Oxacillin-resistant Staphylococcus aureus (OXA-R Sau) an auna a lokacin binciken. An gudanar da kima na asali na ASP a farkon lokacin binciken, sannan kuma ana lura da ci gaban ASP a cikin watanni shida masu zuwa ta amfani da Indicative Compound Antimicrobial (ICATB) Indexididdigar Kula da Lafiya ta Antimicrobial [19].An ƙididdige Matsakaicin ICATB.Gwamnati da ƙungiyoyin kulawa (ICUs) an haɗa su a cikin binciken.
Halayen gama gari na ƙungiyoyin ASPs masu shiga sun haɗa da: (1) Ƙungiyoyin ASP na Multidisciplinary: likitocin cututtuka masu yaduwa, masu harhada magunguna, masu ilimin halitta, masu kula da jinya, kula da kamuwa da cuta da kwamitocin rigakafi;(2) Jagororin rigakafin ƙwayoyin cuta na cututtukan da suka fi yawa, waɗanda ƙungiyar ASP ta sabunta kuma dangane da cututtukan cututtukan da ke cikin cibiyar;(3) yarjejeniya tsakanin masana daban-daban akan jagororin maganin rigakafi bayan tattaunawa da kuma kafin aiwatarwa;(4) mai yiwuwa dubawa da kuma ra'ayi dabara ne ga kowa amma cibiya ɗaya (cibiyar D ta aiwatar da ƙayyadaddun ƙayyadaddun ƙayyadaddun magani (5) Bayan an fara maganin ƙwayoyin cuta, ƙungiyar ASP (yawanci ta hanyar GP mai ba da rahoto ga likita mai kamuwa da cuta) suna bitar takardar sayan da aka zaɓa. ƙwararrun ƙwayoyin cuta da aka tantance kuma suna ba da amsa kai tsaye da shawarwari don ci gaba, daidaitawa, canzawa ko dakatar da jiyya; (6) na yau da kullun (kowane watanni 4-6) ayyukan ilimi don tunatar da likitoci game da jagororin rigakafin ƙwayoyin cuta; (7) tallafin kulawar asibiti don ayyukan ƙungiyar ASM.
An yi amfani da ƙayyadaddun adadin yau da kullun (DDDs) bisa tsarin lissafin Hukumar Lafiya ta Duniya (WHO) don auna yawan amfani da ƙwayoyin cuta.DDD a kowace kwana 100 na gado kafin da bayan shiga tsakani tare da ceftriaxone, cefepime, piperacillin/tazobactam, ertapenem, meropenem, da vancomycin kowane wata a kowane asibiti.
Don auna abin da ya faru na MEM-R Aba, CRO-R Eco, ETP-R Kpn, MEM-R Pae, da OXA-R Sau, adadin marasa lafiya da cututtuka da aka samu a asibiti (bisa ga CDC da ƙananan al'adu-tabbatacce prophylaxis. [ CDC] Ka'idodin Tsarin Kula da Ka'idodin Kulawa) an raba su ta hanyar adadin shiga kowane asibiti (a cikin watanni 6) × 1000 shigar da haƙuri. , Tsare-tsare na keɓewa, tsaftacewa da dabarun lalatawa a cikin asibitocin guda huɗu. A lokacin lokacin kimantawa, ka'idar da Kwamitin Kula da Cututtuka da Cututtuka ya yi ya kasance ba canzawa ba.
An yi amfani da jagororin 2009 da 2010 Clinical and Laboratory Standards Institute (CLSI) jagororin don tantance abubuwan da ke cikin juriya, la'akari da wuraren ɓarke na kowane keɓe a lokacin karatu, don tabbatar da kwatankwacin sakamako.
Binciken jerin lokaci da aka katse don kwatanta amfani da kwayoyin DDD na duniya na wata-wata da tarawar wata shida na MEM-R Aba, CRO-R Eco, ETP-R Kpn, MEM-R Pae, da OXA-R Sau a cikin sassan asibiti da rukunin kulawa mai zurfi. .Amfanin amfani da ƙwayoyin cuta, ƙididdiga da abubuwan da suka faru na cututtuka na riga-kafi, abubuwan da suka faru kafin da kuma bayan sa baki, da canje-canje a cikin cikakkun matakan bayan sa baki. , β2 shine canjin yanayin, kuma β3 shine yanayin bayan shiga tsakani [20] . An yi nazarin ƙididdiga a cikin STATA® 15th Edition. A p-darajar <0.05 an yi la'akari da mahimmancin ƙididdiga.
An haɗa asibitoci hudu a yayin bin watanni 48;Ana nuna halayen su a cikin Table 1.
Kodayake duk shirye-shiryen sun jagoranci masu ilimin cututtuka ko masu cututtuka masu cututtuka (Table 2), rarraba albarkatun ɗan adam don ASPs ya bambanta a fadin asibitoci. Matsakaicin farashin ASP shine $ 1,143 a kowace gadaje 100. Cibiyoyin D da B sun kashe lokaci mafi tsawo don shiga tsakani ASP, aiki 122.93 da 120.67 hours a 100 gadaje kowane wata, bi da bi.Magungunan cututtuka masu yaduwa, masu ilimin cututtuka da kuma likitocin asibiti a cibiyoyin biyu sun kasance suna da sa'o'i mafi girma a tarihi. Institution D's ASP ya kai $ 2,158 ga gadaje 100 a kowane wata, kuma shine abu mafi tsada a cikin 4. cibiyoyi saboda ƙarin ƙwararrun kwararru.
Kafin aiwatar da ASP, cibiyoyi huɗun sun sami mafi girman yaɗuwar ƙwayoyin cuta mai faɗi (ceftriaxone, cefepime, piperacillin/tazobactam, ertapenem, meropenem, da vancomycin) a gabaɗaya da ICUs.Akwai karuwa a cikin amfani (Hoto 1) .Bayan aiwatar da ASP, amfani da ƙwayoyin cuta ya ragu a cikin cibiyoyi;Cibiyar B (45%) ta ga raguwa mafi girma, sannan cibiyoyi A (29%), D (28%), da C (20%).Cibiyar C ta sake canza yanayin amfani da kwayoyin cutar, tare da matakan ma kasa da na farko. lokacin nazarin idan aka kwatanta da na uku bayan aiwatarwa (p <0.001) .Bayan aiwatar da ASP, amfani da meropenem, cefepime, daceftriaxoneya ragu sosai zuwa 49%, 16%, da 7% a cibiyoyin C, D, da B, bi da bi (p <0.001) .Yin amfani da vancomycin, piperacillin/tazobactam, da ertapenem ba a ƙididdige su ba. rage yawan amfani da meropenem, piperacillin/tazobactam, daceftriaxonean lura da shi a cikin shekara ta farko bayan aiwatar da ASP, ko da yake halin bai nuna wani raguwa ba a cikin shekara mai zuwa (p> 0.05).
Halin DDD a cikin amfani da maganin rigakafi mai faɗi (ceftriaxone, cefepime, piperacillin/tazobactam, ertapenem, meropenem, da vancomycin) a cikin ICU da sassan gama gari.
An yi la'akari da ƙididdiga mai mahimmanci a cikin dukkanin maganin rigakafi da aka kimanta kafin a fara aiwatar da ASP a cikin sassan asibiti. Yawan amfani da ertapenem da meropenem ya ragu sosai bayan an aiwatar da ASP. Duk da haka, ba a sami raguwa mai mahimmanci ba a cikin amfani da sauran maganin rigakafi (Table 3). .Game da ICU, kafin aiwatar da ASP, an lura da haɓakar ƙididdiga na sama don duk maganin rigakafi da aka kimanta, sai dai ertapenem da vancomycin. Bayan aiwatar da ASP, amfani da ceftriaxone, cefepime, piperacillin/tazobactam, meropenem, da vancomycin sun ragu.
Dangane da kwayoyin cuta masu jure wa magunguna da yawa, an sami ci gaba mai mahimmanci a cikin OXA-R Sau, MEM-R Pae, da CRO-R Eco kafin aiwatar da ASPs. Ya bambanta, yanayin ETP-R Kpn da MEM-R Aba ba su da mahimmanci a kididdiga. Abubuwan da suka shafi CRO-R Eco, MEM-R Pae, da OXA-R Sau sun canza bayan an aiwatar da ASP, yayin da yanayin MEM-R Aba da ETP-R Kpn ba su da mahimmanci (Table 4). ).
Aiwatar da ASP da mafi kyawun amfani da maganin rigakafi suna da mahimmanci don kashe AMR [8, 21] A cikin bincikenmu, mun lura da raguwa a cikin amfani da wasu magungunan rigakafi a cikin uku daga cikin cibiyoyin hudu da aka yi nazari. Yawancin dabarun da asibitoci ke aiwatarwa na iya taimakawa wajen samun nasara. Daga cikin wadannan asibitoci.hada cewa ASP ta ƙunshi ƙungiyar masu hulɗa da su kamar yadda suke da ƙwararrun manufofin ƙwallon ƙwayoyin cuta tare da masu ƙwarewa kafin aiwatarwa ASP da gabatar da kayan aikin don saka idanu akan yawan amfani da ƙwayoyin cuta, wanda zai iya taimakawa ci gaba da bin diddigin kowane canje-canje a cikin rubutun maganin kashe kwayoyin cuta.
Wuraren kiwon lafiya da ke aiwatar da ASPs dole ne su daidaita ayyukan su ga albarkatun ɗan adam da ake da su da kuma tallafin biyan kuɗi na ƙungiyar kula da ƙwayoyin cuta.Kwarewarmu ta yi kama da wanda Perozziello da abokan aiki suka ruwaito a asibitin Faransanci [22]. Wani muhimmin mahimmanci shine goyon bayan asibitin. gudanarwa a cikin cibiyar bincike, wanda ya sauƙaƙe jagorancin ƙungiyar aikin ASP. Bugu da ƙari, ba da lokacin aiki ga ƙwararrun cututtuka, likitocin asibiti, manyan likitoci da masu aikin jinya shine muhimmin mahimmanci na nasarar aiwatar da ASP [23] .Cibiyoyin B. da C, sadaukarwar GPs na muhimmin lokacin aiki don aiwatar da ASP na iya ba da gudummawa ga babban bin ka'idodin rigakafin ƙwayoyin cuta, kama da rahoton da Goff da abokan aiki [24] suka bayar. amfani da bayar da ra'ayoyin yau da kullun ga likitoci.Lokacin da akwai 'yan kaɗan ko guda ɗaya kawaiƙwararriyar sauƙi a cikin gadaje 800, kyakkyawan sakamakon da aka samu tare da ASP mai kula da jinya sun yi kama da na binciken da Monsees [25] ya buga.
Bayan aiwatar da ASP a cikin sassan gaba ɗaya na cibiyoyin kiwon lafiya guda huɗu a Colombia, an sami raguwar yanayin amfani da duk maganin rigakafi da aka yi nazari, amma ƙididdiga kawai ga carbapenems. Bakteriya masu jure wa magunguna da yawa [26,27,28,29].Saboda haka, rage yawan amfani da shi zai yi tasiri kan abubuwan da ke faruwa na flora masu jure wa magunguna a asibitoci da kuma tanadin farashi.
A cikin wannan binciken, aiwatar da ASP ya nuna raguwa a cikin abubuwan da suka faru na CRO-R Eco, OXA-R Sau, MEM-R Pae, da MEM-R Aba. Sauran nazarin a Colombia kuma sun nuna raguwa a cikin beta mai tsawo. -lactamase (ESBL) -samar da E. coli da kuma ƙara yawan juriya ga cephalosporins na ƙarni na uku [15, 16] . Nazarin kuma sun ba da rahoton raguwa a cikin abin da ya faru na MEM-R Pae bayan gudanarwa na ASP [16, 18] da sauran maganin rigakafi. irin su piperacillin / tazobactam da cefepime [15, 16] .Tsarin wannan binciken ba zai iya nuna cewa sakamakon juriya na ƙwayoyin cuta gaba ɗaya ya dogara da aiwatar da ASP.Wasu abubuwan da ke tasiri akan rage ƙwayoyin cuta masu juriya na iya haɗawa da haɓakawa ga tsabtace hannu. da tsaftacewa da ayyukan kashe kwayoyin cuta, da kuma wayar da kan jama'a game da AMR, wanda maiyuwa ko bazai dace da gudanar da wannan binciken ba.
Darajar ASPs na asibiti na iya bambanta sosai daga ƙasa zuwa ƙasa.Duk da haka, a cikin bita na tsari, Dilip et al.[30]ya nuna cewa bayan aiwatar da ASP, matsakaicin matsakaicin ajiyar kuɗi ya bambanta da girman asibiti da yanki.Matsakaicin ajiyar kuɗi a cikin binciken Amurka shine $ 732 ga kowane mai haƙuri (na 2.50-2640), tare da irin wannan yanayin a cikin binciken Turai. A cikin bincikenmu, Matsakaicin farashi na kowane wata na abubuwa mafi tsada shine $2,158 akan gadaje 100 da sa'o'i 122.93 na aiki a kowane gadaje 100 a kowane wata saboda lokacin da kwararrun kiwon lafiya suka saka.
Muna sane da cewa bincike kan ayyukan ASP yana da iyakancewa da yawa. Ma'auni masu ma'auni irin su sakamako mai kyau na asibiti ko raguwa na dogon lokaci a cikin juriya na ƙwayoyin cuta yana da wuyar dangantaka da dabarun ASP da aka yi amfani da su, a wani ɓangare saboda ɗan gajeren lokacin ma'auni tun lokacin da kowane ASP ya kasance. aiwatarwa. A gefe guda, canje-canje a cikin cututtukan AMR na gida a cikin shekaru na iya rinjayar sakamakon kowane binciken. Bugu da ƙari kuma, ƙididdigar ƙididdiga ta kasa ɗaukar sakamakon da ya faru kafin shigawar ASP [31].
A cikin bincikenmu, duk da haka, mun yi amfani da ƙididdigar jerin lokaci mai katsewa tare da matakan da kuma abubuwan da ke faruwa a cikin ɓangaren riga-kafi a matsayin masu sarrafawa don sashin tsaka-tsakin tsaka-tsakin, samar da tsarin da aka yarda da shi don auna tasirin sa baki.Tun lokacin da raguwa a cikin jerin lokaci ya koma zuwa. takamaiman mahimman bayanai a lokacin da aka aiwatar da shisshigi, ƙaddamar da cewa shiga tsakani kai tsaye yana rinjayar sakamakon da aka samu a cikin lokaci bayan shiga tsakani yana ƙarfafa kasancewar ƙungiyar kulawa da ba ta taɓa yin sa baki ba, don haka, daga riga-kafi zuwa ga Bayan tsaka-tsakin lokaci babu canji. Bugu da ƙari, ƙididdiga na lokaci na iya sarrafawa don tasirin rikice-rikice masu dangantaka da lokaci kamar yanayin yanayi [32, 33]. Ƙididdigar ASP don katse jerin jerin lokuta yana ƙara zama dole saboda buƙatar daidaitattun dabarun, matakan sakamako. , da daidaitattun matakan, da kuma buƙatar samfuran lokaci don zama masu ƙarfi wajen tantance ASP.Duk da fa'idodin wannan hanyar,akwai wasu iyakoki.Yawancin abubuwan lura, ma'auni na bayanai kafin da kuma bayan sa baki, da kuma babban haɗin kai na bayanan duk suna shafar ikon binciken.Saboda haka, idan an ƙididdige yawan raguwar amfani da kwayoyin cuta da raguwa a cikin juriya na ƙwayoyin cuta. ana ba da rahoto akan lokaci, ƙirar ƙididdiga ba ta ba mu damar sanin wanne daga cikin dabaru da yawa da aka aiwatar a lokacin ASP shine mafi inganci saboda ana aiwatar da dukkan manufofin ASP lokaci guda.
Maganin rigakafin ƙwayoyin cuta yana da mahimmanci don magance barazanar AMR masu tasowa. Ana ƙara ba da rahoton kimantawa na ASP a cikin wallafe-wallafen, amma kuskuren hanyoyin da aka tsara a cikin ƙira, bincike, da kuma bayar da rahoto game da waɗannan ayyukan sun hana fassarar da kuma aiwatar da ayyukan da aka yi nasara a fili. ASPs ya girma cikin sauri a duniya, yana da wahala ga LMIC don nuna nasarar irin waɗannan shirye-shiryen.Duk da wasu ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun nazarin nazarin lokaci-lokaci na iya zama da amfani wajen nazarin ayyukan ASP. A cikin binciken mu kwatanta ASPs na asibitoci hudu, mun sami damar nuna cewa zai yiwu a aiwatar da irin wannan shirin a cikin asibitin LMIC. Mun kara nuna cewa ASP yana taka muhimmiyar rawa wajen rage yawan amfani da kwayoyin cuta da kuma juriya. Mun yi imanin cewa, a matsayin manufar kiwon lafiyar jama'a, ASPs. dole ne su sami goyon bayan tsarin mulkin ƙasa, tare da la'akari da cewa su ma a halin yanzu suna cikin niabubuwan da za a iya tabbatar da su na shaidar asibiti da suka danganci amincin majiyyaci.
Lokacin aikawa: Mayu-18-2022