全球抗菌药物消费：世界卫生组织《全球抗微生物药物耐药性行动计划》及2019冠状病毒病大流行（COVID-19）的影响

Global consumption of antimicrobials: impact of the WHO Global Action Plan on Antimicrobial Resistance and 2019 coronavirus pandemic (COVID-19).

作者信息

Khouja Tumader, Mitsantisuk Kannop, Tadrous Mina, Suda Katie J

机构信息

Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.

出版信息

J Antimicrob Chemother. 2022 Apr 27;77(5):1491-1499. doi: 10.1093/jac/dkac028.

DOI:10.1093/jac/dkac028

PMID:35178565

Abstract

BACKGROUND

Little is known about the effect of the COVID-19 pandemic on antimicrobial consumption worldwide.

OBJECTIVES

To describe the impact of the WHO Global Action Plan on Antimicrobial Resistance (GAP-AMR) on antimicrobial consumption pre-pandemic and to evaluate the impact of the COVID-19 pandemic on antimicrobial consumption worldwide.

METHODS

A cross-sectional time-series analysis using a dataset of monthly purchases of antimicrobials (antibiotics, antivirals and antifungals) from August 2014 to August 2020. Antimicrobial consumption per 1000 population was assessed pre-pandemic by economic development status using linear regression models. Interventional autoregressive integrated moving average (ARIMA) models tested for significant changes with pandemic declaration (March 2020) and during its first stage from April to August 2020, worldwide and by country development status.

RESULTS

Prior to the pandemic, antimicrobial consumption decreased worldwide, with a greater apparent decrease in developed versus developing countries (-8.4%, P = 0.020 versus -1.2%, P = 0.660). Relative to 2019, antimicrobial consumption increased by 11.2%, P < 0.001 in March 2020. The greatest increase was for antivirals in both developed and developing countries (48.2%, P < 0.001; 110.0%, P < 0.001) followed by antibiotics (6.9%, P < 0.001; 5.9%, P = 0.003). From April to August 2020, antimicrobial consumption decreased worldwide by 18.7% (P < 0.001) compared with the previous year. Specifically, antibiotic consumption significantly decreased in both developed and developing countries (-28.0%, P < 0.001; -16.8%, P < 0.001).

CONCLUSIONS

The global decrease in antimicrobial consumption pre-pandemic suggests a positive impact of the WHO GAP-AMR. During the pandemic, an initial increase in antimicrobial consumption was followed by a decrease worldwide. AMR plans should specify measures to ensure full implementation of AMR efforts during health crises such as the COVID-19 pandemic.

摘要

背景

关于新冠疫情对全球抗菌药物消费的影响，人们了解甚少。

目的

描述世界卫生组织抗菌药物耐药性全球行动计划（GAP-AMR）在疫情前对抗菌药物消费的影响，并评估新冠疫情对全球抗菌药物消费的影响。

方法

采用2014年8月至2020年8月抗菌药物（抗生素、抗病毒药物和抗真菌药物）月度采购数据集进行横断面时间序列分析。使用线性回归模型按经济发展状况评估疫情前每千人口的抗菌药物消费量。采用干预自回归积分滑动平均（ARIMA）模型，在全球及按国家发展状况测试疫情宣布（2020年3月）时以及2020年4月至8月第一阶段是否有显著变化。

结果

在疫情之前，全球抗菌药物消费量下降，发达国家的下降幅度明显大于发展中国家（-8.4%，P = 0.020，而发展中国家为-1.2%，P = 0.660）。与2019年相比，2020年3月抗菌药物消费量增加了11.2%，P < 0.001。发达国家和发展中国家抗病毒药物的增幅最大（分别为48.2%，P < 0.001；110.0%，P < 0.001），其次是抗生素（分别为6.9%，P < 0.001；5.9%，P = 0.003）。与上一年相比，2020年4月至8月全球抗菌药物消费量下降了18.7%（P < 0.001）。具体而言，发达国家和发展中国家的抗生素消费量均显著下降（分别为-28.0%，P < 0.001；-16.8%，P < 0.001）。