抗菌药物管理项目对儿科抗菌药物使用合理性的影响

Impact of antimicrobial stewardship program on appropriateness of antimicrobial use in pediatric

目的 评价抗菌药物管理项目(ASP)对儿科抗菌药物使用合理性的影响。方法 基于国际上施行的ASP的经验,在某三级综合医院儿科病房实施干预措施,包括教育、制定临床路径、医嘱点评和反馈、药学咨询和多学科病例讨论等。对干预前(2019年)和干预后(2021年)出院患者抗菌药物的使用量进行统计,对使用合理性进行评价,并记录治疗失败率。结果 干预前组纳入患者1 427例,干预后组纳入患者536例。干预前组抗菌药物每千人日使用天数为1 013.30,干预后组抗菌药物每千人日使用天数为979.78,下降3.31%。干预前组不合理例数为408例,不合理率为30.37%;干预后组不合理例数为78例,不合理率为15.15%。2组不合理率经比较,差异具有统计学意义(χ^(2)=44.727,P <0.001)。结论 实施ASP不仅使儿科抗菌药物合理使用水平得到了提高、而且不会引起治疗失败率的变化。但存在一些问题,包括抗菌药物每千人日使用天数仍较高,干预过程信息化程度不高等,有待进一步改善。

AIM To evaluate the impact of implementation of antimicrobial stewardship program(ASP)on the rationality of antimicrobial use in pediatrics.METHODS Based on the international ASP strategy goal,antimicrobial management intervention which included education,formulation of clinical pathway,audit and feedback of medical orders,pharmacists-consultation and multidisciplinary case discussion was implemented in pediatric ward of a tertiary general hospital.The consumption of antimicrobials of all discharged patients before intervention(2019)and after intervention(2021)was counted,the rationality of use was evaluated,and the treatment failure rate was recorded.RESULTS Totally 1427 patients were included in the pre intervention group and 536 patients were included in the post intervention group.The days of antibiotic therapy(DOT)per 1000 patients days of antimicrobials was 1013.30 in the pre intervention group and 979.78 in the post intervention group.It decreased 3.31%.The amounts of cases of irrational antimicrobial use in the pre intervention group was 408,accounting for 30.37%.The amounts of cases of irrational antimicrobial use in the post intervention group was 78,accounting for 15.15%.There was significant difference between 2 groups(χ^(2)=44.727,P<0.001).CONCLUSION The implementation of ASP improves the appropriateness of antimicrobial use in pediatric ward.And treatment failure rate is identical.However,there are still some problems,including the high level of DOT per 1000 patients days of antimicrobials and the low level of informatization in the intervention process.