连续7年动态监测抗菌药物使用与控制的评价

Evaluate effect of monitoring and control on use of antibiotics for continuously seven years

目的动态了解医疗机构抗菌药物使用情况,评价抗菌药物使用的合理性及控制效果。方法 2004-2010年每月采用统一标准,监测固定数量住院患者抗菌药物的使用率,应用抗菌药物治疗患者的病原学送检率及Ⅰ类手术切口抗菌药物预防使用合理性,对严重不合理者进行干预。结果 2004-2010年共监测38 049例住院患者,手术科室住院患者19 778例,非手术科室住院患者18 271例,通过监测和干预,抗菌药物使用率从2004年的71.80%降到56.24%,下降了15.56%,7年中手术科室抗菌药物使用率平均为80.60%,明显高于非手术科室的42.39%(P<0.01);病原学送检率逐年上升,由2004年的15.16%,升至2010年的56.27%;Ⅰ类手术围手术期抗菌药物预防使用经干预,预防用抗菌药物使用时限逐年明显下降,2010年较2005年缩短了50.00%,围手术期抗菌药物预防在术前规范使用率明显上升,由2005年的44.01%上升至2010年的87.64%。结论通过控制措施可降低医疗机构抗菌药物使用率、Ⅰ类手术预防用抗菌药物使用时限及抗菌药物治疗者的病原学送检率。

OBJECTIVE To investigate the antibiotic use in inpatients,and evaluate the efficacy of the monitoring and control measures.METHODS 500 inpatients were randomly selected per year from 2004 to 2010,including surgical patients and non-surgical patients.To determine the antimicrobial usage in inpatients,the perioperation prophylactic use of antibiotics in patients with type 1 incision operation and the ratio of samples was sent for pathogen detection from inpatients who were on antibiotics for therapy were analyzed.Inappropriate use of antibiotics in inpatients was intervened at the same time.RESULTS The operation department of antibiotics usage is obviously higher than that of the non-operative departments（15941/19778 to 7745/18271;80.60% to 42.39%）.A total of 38 049 cases were monitored in 7 years,including 19 778 surgical patients and 18 271 non-surgical patients.After continuous intervention,the usage rate of antibiotics decreased and antimicrobial use time in type 1 incision operation prevention were shortened year by year（compared with that in 2004,decrease by 21.67% and 50.00% respectively in 2010）.Antibiotics for therapy etiology inspection rate increased year by year,（increased by 270.20% compared with 2004）.The perioperation prophylactic of 0.5-2 hour preoperation utilization ratio increased 101.91%,which were closely related with the implementing control infection.CONCLUSION We can reduce hospital antimicrobial usage,antimicrobial treatment time in surgery and the etiology of inspection rates through the control measures for therapy.