碳青霉烯类抗菌药物合理应用管理实效分析及思考

Effectiveness analysis and inspirations of rational administration of carbapenem

介绍了我院通过多科协作管理的方式对碳青霉烯类药物合理使用进行管控的做法，即医务处对医师进行培训与考核并开展每月病历检查，药事科进行事前审方和事后点评，临床微生物室及感染管理科监测全院感染及细菌耐药信息并实时发布。结果显示，2017年6—12月亚胺培南西司他丁钠用量增加而比阿培南用量降低；耐药结果分析显示碳青霉烯类耐药菌株数增加28％，但患者总例数降低10％，多重耐药患者总数未增加。拟通过进一步推进院内AMS（antimicrobialstewardship）建设来实现合理用药，遏制细菌耐药。

The hospital introduced a multi-department synergy in management of the rational use of carbapenems. Specifically, the medical affairs department conducts training and appraisal of doctors along with a monthly checkup of medical records. The pharmaceutical affairs division conducts prior prescriptions checkup and follow-up comment. The clinical microbiology laboratory and the hospital-acquired infection management department monitors and releases such infection and bacterial resistance information of the whole hospital in real time. The results showed increased prescriptions of imipenem and cilastatin sodium, and decreased prescriptions of biapenem for injection. Drug resistance analysis showed that earbapenem resistant strains increased by 28%, but the total number of patients reduced by 10% and total number of patients with multidrug resistance remained unchanged. It is proposed to further antimicrobial stewardship in the hospital to achieve rational drug use and curb bacterial resistance.