Ⅰ类切口预防性使用抗菌药物干预后的时间趋势分析

Time trend analysis on the prophylactic use of antibiotics in typeⅠincision surgery patients after the intervention

目的评价干预后Ⅰ类切口围手术期预防性使用抗菌药物的变化趋势,探讨干预措施在提高预防性使用抗菌药物的作用。方法收集医院2011年7月-2014年6月Ⅰ类切口围手术期预防性使用抗菌药物的监测资料,每月随机抽样监测Ⅰ类切口50份病历,对预防抗菌药物使用率、用药指征、用药时机、药物选择方面进行评价,逐月计算预防性抗菌药物使用率及不合理率,通过线性回归模型及曲线拟合,估计不合理率的月度变化百分比(MPC)及预测其未来发展趋势;同时分析各不合理率变化在总不合理率趋势改变中的贡献。结果 1 800例Ⅰ类切口患者纳入研究,抗菌药物使用率月均降减3.295,不合理率月均降减4.372,变化趋势均差异有统计学意义(P<0.01);曲线模拟预测不合理率将进一步下降,并有望达到控制目标;月度变化贡献率分析显示,用药指征不合理下降对不合理率下降的贡献最大,达68.53%。结论医院Ⅰ类切口围手术期抗菌药物预防性使用不合理率变化呈明显下降趋势,实施干预措施后产生了积极的作用。

OBJECTIVE To evaluate the tendency of the prophylactic use of antibiotics in type Ⅰ incision surgery patients after the intervention,and discuss the effect of intervention on the improvement of the prophylactic use of antibiotics.METHODS The monitoring data of the prophylactic use of antibiotics in type Ⅰ incision surgery patients in the hospital were collected from Jul.2011 to Jun.2014.R Totally 50 cases of type Ⅰincision surgery patients were randomly sampled every month.The percentage of the prophylactic use of antibiotics,medication indications,timing of using antibiotics and the inappropriate choice of antibiotics were evaluated.The perioperative antibiotics utilization rate and the unreasonable rate were calculated monthly.MPCs（monthly percent changes）were estimated by a linear regression of the logarithm on the illogicality rates and the future development trend was predicted by curve fitting.It also partitioned the contributions of each illogicality rate into the overall floating trend.RESULTS A total of 1800 patients were included in the study.The MPCs of the perioperative antibiotics utilization rate and the unreasonable rate were-3.295% and-4.372%,and the changes had significances（P〈0.01）.The unreasonable rate which was predicted by curve fitting would continue drop month by month and was expected to achieve the control objectives.According to the calculated monthly change contribution ratio,the unreasonable rate of the indications of drug use contributed the most to the decline of the incidence rate,reaching68.53%.CONCLUSIONThe unreasonable rate of the perioperative antibiotics utilization in typeⅠincision surgery patients showed an obvious decline tendency,which meant that the intervention took positive effect.