政策干预对9808例心脏介入操作抗菌药物预防性应用的影响

Impact of antibiotics management guideline on antibiotics prophylaxis during cardiovascular interventional procedures

目的评价抗菌药物管理措施对医院心脏介入操作(CI)抗菌药物预防性使用的影响。方法回顾性分析2011年4月-2012年11月通过计算机网络信息系统收集施行CI的患者资料,包括住院天数、介入操作类型、抗菌药物使用、体温、白细胞计数等,比较政策干预前后抗菌药物预防性使用率,预防性抗菌药物使用强度(DDD)、使用抗菌药物种类和术后疑似感染率,评价干预措施效果。结果共收集10 135例患者资料,排除操作时或前3d内有发热或其他感染者,共纳入研究9808例,男性占64.8%,年龄(58.1±14.9)岁,住院时间(5.3±3.2)d;政策干预前、后,冠状动脉造影术及经皮冠状动脉介入治疗的抗菌药物预防性使用率分别为78.0%和5.2%;使用强度分别为每100床日数12.1和7.1;同期术后疑似感染率分别为1.9%和2.6%(P=0.078);心脏电生理联合射频消融术在政策干预前后的抗菌药物预防性使用率分别为87.8%和22.8%;抗菌药物使用强度100个床日数为14.8和4.6;同期疑似感染率为4.1%和4.6%(P=0.548)。结论抗菌药物政策干预显著降低了CI中抗菌药物的使用率和使用强度,且术后疑似感染率无明显增加。

OBJECTIVE To evaluate the effect of antibiotics management guideline on the antibiotic prophylaxis during cardiovascular interventional procedures. METHODS This study was designed as a retrospective one from Apr, 2011 to Nov, 2012. All the records of patients who received cardiovascular interventions have been collected by computer information system, including length of stay, types of cardiovascular interventional procedures, regime of antibiotic prophylaxis, temperature, WBC, etc. The utilization rate of prophylactic antibiotics, DDD, types of antibiotics used, and postoperative suspected infection rate before and after the implement of antibiotic management guideline were used to evaluate the effectiveness of the interventions. RESULTS Among 10 135 cases, excluding the cases with fever or other infection at the time of operation or within three days, 9 808 cases were qualified according to the inclusion criteria, the male accounted for 64.8%, the average age was （58.1±14. 9） year, the length of stay was（5.3±3.2）days. The utilization rates of the prophylactic antibiotics of the patients who received coronary angiography and PCI before and after the implement of antibiotics management guideline were 78.0% and 5.2%, respectively. The DDDs were 12. 1 per 100 bed days and 7.1 per 100 bed days , respec- tively% Meanwhile, the suspected infection rates were 1.9% and 2.6%, respectively（P=0. 078）% the utilization rate of the prophylactic antibiotics of the patients who received cardiac electroph.ysiology and Catheter ablation be- fore and after the implementation of the antibiotics management guideline were 87.8% and 22.8%, respectively; the DDDs were 14.8 per 100 bed days and 4.6 per 100 bed days , respectively , at the same period, the suspected infection rates were 4.1 % and 4.6 % , respectively（P = 0. 548）. CONCLUSION The implementation of antibiotic management guideline on antibiotics prophylaxis has remarkably reduced both the utilization rate of antibiotics and the DDD during the cardiovascular interventional procedures, without significant increase in the incidence of sus- pected infections.