干预前后住院患者抗菌药物应用横断面调查对比分析

Comparative analysis of cross-sectional investigation on clinical application of antimicrobials used by inpatients before and after intervention

目的评价某综合医院加强抗菌药物临床应用管理的成效,为临床合理用药提供参考。方法采用横断面调查的方法,调查2010年12月30日(干预前)及2011年12月14日(干预后)某院住院患者抗菌药物及手术围术期抗菌药物的使用情况。结果抗菌药物使用率由48.4%降至38.3%(χ2=12.07,P<0.005);预防使用比例由39.4%降至28.9%(χ2=6.04,P<0.025);联合用药比例由37.5%降至27.2%(χ2=6.01,P<0.025);治疗使用抗菌药物病原学送检率由36.3%上升52.7%(χ2=8.93,P<0.005);手术围术期抗菌药物的预防使用率由98.8%降至90.4%(χ2=11.8,P<0.005),其中Ⅰ类切口的预防使用率由99.0%降至85.7%(χ2=12,P<0.005);术前30min开始用药比例由72.0%上升至83.9%(χ2=6.66,P<0.01);第三代头孢菌素的使用率由32.6%降至24.1%,差异无统计学意义。结论加强多部门联动监管,可提高抗菌药物临床应用的合理性。

OBJECTIVE To evaluate the effectiveness of strengthening the clinical application of antibiotics in a general tertiary hospital so as to provide basis for the reasonable clinical medication.METHODS Using the cross-sectional investigation method,the use of antimicrobials and antibiotics during perioperative period of incision operation for the hospitalized patients on Dec.30,2010（before intervention） and Dec.14,2011（after intervention） was investigated.RESULTS The use rate of antimicrobials decreased from 48.4% to 38.3%（χ2=12.07,P0.005）;the constituent ratio for preventive drug use decreased from 39.4% to 28.9%（χ2=6.04,P0.025）;the constituent ratio for combined drug use decreased from 37.5% to 27.2%（χ2=6.01,P0.025）;the rate of therapeutic drug for etiologic test increased from 36.3% to 52.7%（χ2=8.93,P0.005）;the rate of preventive use of antibiotics during perioperative period of incision operation decreased from 98.8% to 90.4%（χ2=11.8,P0.005）;the rate of preventive use of antibiotics during perioperative period of typeⅠincision operation decreased from 99.0% to 85.7%（χ2=12,P0.005）;the constituent ratio of use of antibiotics 30min before the operation increased from 72.0% to 83.9%（χ2=6.66,P0.01）;the use rate of the third-generation cephalosporin decreased from 32.6% to 24.1%,the difference was not statistically significant.CONCLUSION To strengthen the multi-sectoral integrated supervision can improve the rationality of clinical application of antibiotics.