专项整治活动对我院抗菌药物合理应用和减缓细菌耐药性的效果评价

Evaluation of the Effect of Special Rectification on the Rational Use of Antibiotics and Relieving Bacterial Resistance in Our Hospital

目的:评价抗菌药物临床应用专项整治活动对我院抗菌药物合理应用及减缓细菌耐药性的效果。方法:按抗菌药物专项整治前后3年进行分组,比较两组抗菌药物临床应用相关指标及细菌耐药性等数据。结果:专项整治后,住院患者抗菌药物使用率从77%降至55%,抗菌药物使用强度从86 DDDs/(100人·d)降至39 DDDs/(100人·d),Ⅰ类切口手术患者预防使用抗菌药物比例从98%降至27%,门、急诊患者抗菌药物处方比例分别从36%、49%降至12%、23%。微生物检验标本送检率从20.2%升至38.8%,无菌部位标本送检率从29.8%升至37.6%。真菌检出率从14.4%降至11.2%。大肠埃希菌、肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)菌株的检出率分别从57.3%、43.2%降至51.3%、36.1%。居前5位细菌的多重耐药菌总检出率从48.4%降至29.3%,但2014年多重耐药鲍曼不动杆菌检出率升至80.7%,鲍曼不动杆菌对亚胺培南、美罗培南的耐药率分别达到66.9%、69.1%。肺炎克雷伯菌对第一、二、三代头孢菌素类、哌啦西林/他唑巴坦、亚胺培南、美洛培南的耐药性有增加趋势。结论:抗菌药物专项整治活动效果明显,提高了医院抗菌药物临床应用的管理水平,但细菌耐药形势仍然严峻,需要建立抗菌药物临床应用长效管理机制,加强病原学检查和细菌耐药性监测,严格执行手卫生和消毒隔离制度。

OBJECTIVE： To evaluate the effect of special rectification on the rational use of antibiotics and relieving bacterial resistance. METHODS ： It was divided into groups based on the before and after 3 years of special rectification. The data of related index and bacterial resistance of antibiotics in the clinical use in 2 groups were compared. RESULTS： After special rectification, the use rate of antibiotics in inpatients was decreased from 77% to 55 %, use intensity was decreased from 86 DDDs / （100 person. d） to 39 DDDs/（100 person, d）, the prophylactic use rate of antibiotics for type I incision surgery was decreased from 98% to 27%, the antibiotics prescriptions of patients in outpatient and emergency departments were respectively decreased from 36% to 12% and 49% to 23%. The submission rate of microbiological testing specimens was increased from 20.2% to 38.8%, submission rate of sterile site specimens was increased from 29.8% to 37.6%. The detection rate of fungus was decreased from 14.4% to 11.2 %. The detection rates of Escherichia colt and Klebsiella pneumoniae producing extended-spectrum 13- lactamases （ESBLs） strains were respectively decreased from 57.3% to 51.3% and 43.2% to 36.1%. The total detection rate of top 5 multi-drug resis- tant bacteria was decreased from 48.4% to 29.3% , however, the detection rate of Acinetobacter baumannii was increased to 80.7%, and the resistance rates of Acinetobacter baumannii to imipenem and meropenem were respectively 66.9% and 69.1%. There was an increasing trend for Klebsiella pneumoniae to 1, 2 and 3-generation cephalosporins, piperacillin amoxicillin/tazobac- tam, imipenem, meropenem. CONCLUSIONS： Special rectification of antibiotics has obvious effect on the rational use of antibiot- ics and relieving bacterial resistance in the clinic, and it improves the management of clinical use of antibiotics in hospital. Howev- er, bacterial resistance situation is still grim, it needs to establish a long-term management mechanism of clinical use of antibiotics, strengthen the monitoring pathologic examination and monitoring of bacterial resistance, and strictly perform hand hygiene and disinfection and isolation system.