我院围术期预防使用抗菌药物改进情况分析

Analysis of the Improvement of Perioperative Antibiotic Prophylaxis in Our Hospital

目的分析我院加强抗菌药物管理后,3种切口围术期预防使用抗菌药物的改善情况,为临床合理使用抗菌药物提供参考。方法随机抽取2011年1月到10月139份手术病例为对照组,2012年1月到10月150份手术病例为监测组。比较两组不同切口类别之间的手术部位感染率、抗菌药物使用率、平均用药天数,抗菌药物使用费用及抗菌药物使用的合理性等情况,以观察监测组是否有显著性改善。结果手术部位感染率两组之间没有显著性差异(P=1.00);Ⅰ类切口监测组在抗菌药物使用率(P<0.001)、平均用药天数(P=0.001)、平均住院费用(P=0.006)、平均药费(P<0.001)、平均抗菌药物费用(P<0.001)、平均抗菌药物费用/平均住院费用(P<0.001)、药物选择合理率(P=0.003)、术中追加用药合理率(P=0.007)上都明显好于对照组;Ⅱ类切口监测组在平均用药天数(P=0.05)、平均抗菌药物费用(P=0.015)、平均抗菌药物费用/平均住院费用(P=0.03)、术前用药时间合理率(P<0.001)、术后用药时间合理率(P=0.001)方面显著好于对照组;而Ⅲ类切口只有平均抗菌药物费用/平均住院费用(P=0.046)和术后用药时间合理率(P=0.057)两项好于对照组。结论我院加强抗菌药物管理的措施对Ⅰ类切口手术预防用抗菌药物情况的改善是有意义的并且取得了良好的效果。在以后的管理中,我们还需要进一步加强对Ⅱ类和Ⅲ类切口手术预防用抗菌药物的管理。

OBJECTIVE To analysis the improvement of perioperative antibiotic prophylaxis in 3 kinds of surgical incisions after we strengthened the management of antibiotics in our hospital and provide reference for clinical rational use of antibiotics. METHODS Random selected 139 medical records from January to October in 2011 as the control group, and random selected 150 medical re- cords from January to October in 2012 as the monitoring group. Compared the surgical site infection rates, antimicrobial utilization rate, the average number of medication days, the cost of antimicrobial drugs and the rationality of the antibiotics, etc. between the two groups in order to investigate if the monitoring group significantly improved. RESULTS There was no significant difference （ p = 1. 00） in Surgical site infection rates between the two groups. The antimicrobial utilization rate （P 〈 0. 001 ） , the average number of medication days （ P = 0.001 ） , the average cost of hospitalization （ P = 0. 006） , the average drug costs （ P 〈 0. 001 ） , the average anti- bacterial drug costs （ P 〈 0. 001 ）, the average antibacterial drug cost / the average cost of hospitalization （ P 〈 0. 001 ）, the reasonable rate for the choice of the drug（ P = 0.003 ）, the reasonable rate for the intraoperative medication time （ P = 0. 007 ） in the monitoring group were significantly better than the control group in type 1 incision operation; in type 2 incision operation the average number of medication days（ P = 0.05 ） , the average antibacterial drug costs （ P = 0.015 ）, the average antibacterial drug costs / the average inpa- tient costs （ P = 0.03 ） , the reasonable rate for the preoperative medication time （ P 〈 0. 001 ） , thereasonable rate for the postoperative medication （P = 0. 001 ） in the monitoring group were significantly better than the control group; and in type 3 incision operation only the average antibacterial drug costs / the average inpatient costs （ P = 0. 046） and the reasonable rate for the intraoperative medication time （ P = 0. 057 ） in the monitoring group were significantly better than the control group. COMCLUSION The Measures to strengthen the management of antimicrobial drugs in our hospital can improve the rational use of antimicrobial agents in type 1 incision operation. However, we need to further strengthen the management of preventive antibacterial drugs in type 2 and type 3 incision operation.