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- Author or Editor: Ádám Visnyovszki x
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Az antibiotikum ambuláns alkalmazásának jellemzői és tendenciái Magyarországon (2010–2019)
The characteristics and trends of Hungarian outpatient antibiotic use (2010–2019)
Összefoglaló. Bevezetés: Az antibiotikumok észszerű alkalmazása kulcsfontosságú a hatékonyságuk megőrzésében és a néhol kritikus méreteket öltő antibiotikumrezisztencia visszaszorításában. Célkitűzés: A hazai ambuláns antibiotikumfelhasználás jellemzőinek, trendjeinek bemutatása. Módszer: A 2010 és 2019 közötti időszakra vonatkozó, dobozszámban kifejezett ambuláns szisztémás antibiotikumfelhasználási adatokat – a WHO 2019. évi indexe alapján – „defined daily dose” (DDD – napi átlagdózis) egységbe konvertáltuk. Standardizált technikai egységünk a DDD/1000 fő/nap volt (DID). Az antibiotikumfelhasználás értékelésére nemzetközileg elfogadott minőségi indikátorokat alkalmaztunk. Eredmények: Az antibiotikumfelhasználás mértéke kismértékű ingadozást mutatott (min.: 12,9 DID, max.: 14,7 DID), viszont a szezonális ingadozás a teljes megfigyelt időszakban jelentős mértékű volt. A széles versus szűk spektrumú béta-laktámok és makrolidek felhasználási hányadosa évről évre tovább emelkedett (2010: 13,3 vs. 2019: 71,6), a fluorokinolonok alkalmazási aránya továbbra is meghatározó (2010: 14,3%, 2019: 14,5%). A vizsgált 12 minőségi indikátor közül a tanulmány nyitó évében 4, a tanulmány záró évében 6 indikátor esetében a legkedvezőtlenebbül teljesítő európai országok közé tartoztunk. Megbeszélés: A hazai antibiotikumalkalmazás mértéke európai mérce szerint nem magas, de csökkentésére látszik lehetőség; mintázata szuboptimális, és az évek során kedvezőtlen irányba változott. Következtetés: A kapott antibiotikumfelhasználási adatok s azok értelmezése alapján rendkívül sürgető morális kötelesség a szakmai és hatósági intervenciókra épülő hazai antibiotikumstratégia és -akcióterv mielőbbi kidolgozása, implementálása. Orv Hetil. 2022; 163(4): 140–149.
Summary. Introduction: Prudent antibiotic use is an important tool to preserve their effectiveness as well as reverse and confine antibiotic resistance. Objective: To evaluate the trends and characteristics of Hungarian outpatient antibiotic use. Methods: Crude, package level antibiotic sales data for the period 2010–2019 were converted into DDD (defined daily dose) and were standardized for 1000 inhabitants and per year (ATC-DDD index, version 2019). Internationally validated drug-specific quality indicators were used to evaluate antibiotic use. Results: The scale of antibiotic use was stagnating with minimal fluctuation (min.: 12.9 DID, max.: 14.7 DID), and with high intra-year seasonality index. The ratio of the consumption of broad to narrow spectrum beta-lactams and macrolides increased gradually from year to year (2010: 13.3 vs. 2019: 71.6) and the relative consumption of fluoroquinolones is still remarkable (2010: 14.3%, 2019: 14.5%). Out of the twelve surveyed drug-specific quality indicators in the first and last year of analysis, we were ranked among the weakest European countries in the case of four and six indicators, respectively. Discussion: The scale of Hungarian outpatient antibiotic use is not high, in European comperison, but has some reserve capacity for reduction. The pattern of Hungarian antibiotic use is suboptimal and had further decreased quality through the years. Conclusion: Based on the recorded data of antibiotic use and their interpretation, the development of national antibiotic strategy (including both professional and authority interventions) is a pressing moral obligation. Orv Hetil. 2021; 163(4): 140–149.
Abstract
Background
In December 2019, pneumonia caused by coronavirus Disease-19 (COVID-19) occurred in Wuhan, Hubei Province, China. Currently, COVID-19 has spread worldwide. In accordance with the restrictions of the Hungarian Government, several epidemic hospitals and centers have been established in Hungary. The first infected patient was detected on 4th March, 2020 in our country, who was not a Hungarian citizen. The first patient died of pneumonia caused by COVID-19 was on 15th March. The Hungarian epidemic curve is flattened and more prolonged. We aimed to report our computer tomography (CT) findings in correlation with clinical status in patients with COVID-19 infection.
Material and methods
All patients with laboratory-identified Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection by real-time polymerase chain reaction (PCR) and who underwent chest CT were collected between March 26, 2020, and April 20, 2020, in our hospital. In our centre we had 107 PCR confirmed COVID-19 positive patients in this period. 52 patient (male: female 1:2, average age: 67.94) were admitted to our central epidemic hospital, according to their complains: fever, dyspnoea, hypoxaemia, altered mental status, comorbidity, sepsis or if patient isolation could not be performed. In case of every patient we took blood test, nasopharyngeal sample and a chest CT without contrast agent. In our CT report we used a score system to characterize the severity.
Results
The majority of infected patients had a history of exposure in nursing homes and mostly presented with fever and cough. The present study confirmed the findings about results of other researches. The COVID-19 pneumonia affected the elderly patients, caused hypoxia, cough and sepsis. On the CT scan, typical signs were seen in the cases of PCR confirmed patients.
Conclusion
The limitations of the present study include the low number of patients. Collectively, our results appear consistent with previous studies. Chest CT examination plays an important role in the diagnosis and estimation of the severity of the novel coronavirus pneumonia. Future research should examine strategically the features of the Hungarian population.