住院患者抗菌药物合理使用国际指标的调查干预研究

Investigation and Intervention of the Antimicrobial Agent Use in Hospitalized Patients by Selected Indicators

目的探讨抗菌药物合理使用国际指标在我国医院的实用性,提高医院抗菌药物合理使用水平。方法按照抗菌药物合理使用国际指标对某一三甲医院住院患者进行现场调研,采用行政管理和宣传教育等多手段进行干预。医院整体情况数据通过管理部门和药库获得,处方行为和患者治疗情况通过系统抽样方法采集。用SPSS12·0软件进行统计分析。结果接受抗菌药物治疗的住院患者使用抗菌药物的平均品种数从干预前的2·07种降到干预后的1·79种,接受抗菌药物治疗的患者的平均费用从干预前的1597·61元降到干预后的1036·19元(P<0·05),单种抗菌药物的平均使用天数从干预前的5·21d下降到干预后的4·38d(P<0·05),接受抗菌药物治疗患者的平均住院日从干预前的14·41d下降到干预后的12·26d,其他多项指标均有改善。结论本研究所采用的抗菌药物合理使用国际指标调研具有实用性,干预措施有效,实施《抗菌药物临床应用指导原则》促进了抗菌药物的安全、经济、合理使用。

OBJECTIVE To explore the feasibility of a set of indicators that evaluate the rational use of antimicrobial agents in China and to improve the rational use of antimicrobial agents with multidisciplinary intervention strategies. METHODS The selected indictors recommended by WHO/ INRUD were applied to evaluate the use of antimicrobial agents in hospitalized patients. The health facility information was gained from hospital administration section. The prescription and treatment data were collected from the discharged patients＇ medical history. Intervention was involved in managerial and educational strategies. RESULTS After intervention, the average number of antimicrobial agents prescribed per hospitalization with antimicrobial agents prescribed fell from 2.07 to 1.79. .The average cost of antimicrobial angents prescribed per hospitalization with antimicrobial agents prescribed fell from 1 597.61 yuan to 1 036. 19 yuan （P 〈0. 05 ）. The average duration of prescribed antimicrobial treatment was 5.21 d in 2004 and 4. 38 d in 2005 （P 〈 0. 05）. The average hospital stay of patients who receive antimicrobial agents fell from 14. 41 d to 12. 26 d. The percentage of surgical inpatients that received antimicrobial prophylaxis fell from 86. 4% to 80. 3%. Some other indicators also were increased, which imply the benefit of the intervention. CONCLUSION The indicators and methods are proved to be scientific and potentially useful in Chinese hospital. The intervention is effective. The implement of guidelines promote rational, safety and cost-effective use of antimicrobial agents.