实施综合干预对降低住院患者抗菌药物使用率效果的Meta分析

Meta-analysis of the Effects of Comprehensive Intervention Method on the Utilization Ratio of Antibiotics among Inpatients

目的:系统评价实施综合干预对降低住院患者抗菌药物使用率的效果。方法:全面检索中国期刊全文数据库、万方数据库、中文科技期刊全文数据库的相关文献,按文献纳入/排除标准对检索到的文献进行相关性评价和质量评价,采用RevMan5.0统计学软件对纳入的文献进行Meta分析。结果:实施综合干预后,住院患者抗菌药物使用率显著下降,与实施前比较差异有统计学意义[RD=-0.08,95%CI(-0.10,-0.06),P<0.01]。按抗菌药物使用基线率、重测时间和医院级别进行亚组分析,结果显示上述3个因素并不能完全解释异质性产生的原因。结论:在医院实施综合干预可有效降低住院患者抗菌药物使用率。但由于纳入研究质量不高,降低了结论的可靠性,建议以后多开展随机对照试验以便为临床提供更可靠的循证医学证据。

OBJECTIVE： To systematically evaluate the effects of comprehensive intervention methods on reduction of utiliza- tion ratio of antibiotic among inpatients. METHODS： Retrieved from CNKI, Wanfang database and VIP database, correlation and quality evaluation were conducted in relevant literatures met inclusion and exclusion criteria. Rev Man 5.0 software was adopted for Meta-analysis of the included studies. RESULTS： After comprehensive intervention, the utilization ratio of antibiotics decreased [RD= - 0.08,95% CI （ - 0.10, -- 0.06）, P〈0.01]. Sub-group analysis was conducted for base utilization rate of antibiotics, time for re-test and the grades of hospitals, and results of sub-group analysis revealed the three factors could not completely explains the heterogeneity. CONCLUSIONS： The comprehensive intervention can decrease the proportion of antibiotics effectively. But because the studies are not high quality, reducing the reliablity of the conclusion, we suggested carrying out randomized study to proviede more reliable clinical evidence-based.