多项举措改善Ⅰ类切口手术围手术期抗菌药物应用

Multiple measures to improve perioperative antimicrobial use in type Ⅰ incision operation

目的：评价某院采取多项举措干预Ⅰ类切口手术围手术期患者抗菌药物使用的效果，为抗菌药物合理应用提供依据。方法对2005—2012年该院每年4月份和10月份9823例Ⅰ类切口手术患者进行回顾性调查，以2005年的数据为基线，2006—2012年采取培训、考核、监督、反馈及与相关部门合作等多项举措进行干预，比较干预前后抗菌药物使用情况。结果Ⅰ类切口手术围手术期患者抗菌药物使用合格率从2006年的14．20％提高至2012年的92．30％；2006—2009年抗菌药物联合用药率偏高（7．00％～9．00％），2010—2012年呈下降趋势，2012年下降至3．20％。2006和2007年该院Ⅰ类切口手术预防使用抗菌药物种类与2005年（基线）基本相似，主要为头孢菌素类、青霉素及其复合制剂、氨基糖苷类；2008—2012年预防使用的主要抗菌药物是第一、二代头孢菌素，青霉素类及其复合制剂。多因素非条件 logistic 回归分析结果显示，年龄（40～59岁）、科室（骨科、普通外科和眼科）和年份（2011和2012年）是抗菌药物使用合格与否的主要影响因素（均 P ＜0．05）。结论采取多项举措进行干预可提高Ⅰ类切口手术围手术期抗菌药物使用合格率，减少使用抗菌药物种类，降低联合用药率。

Objective To evaluate the effect of multiple intervention measures on perioperative antimicrobial use in pa-tients undergoing typeⅠincision operation in a hospital,and provide basis for rational use of antimicrobial agents. Methods 9 823 patients with type I incision operation in April and October of 2005-2012 were surveyed retrospectively, data of 2005 was as baseline,from 2006 to 2012,multiple measures,including training,examination,supervision,feed-back,and cooperation of relevant departments were conducted,antimicrobial use before and after intervention was com-pared.Results The qualified rate of perioperative antimicrobial use in patients undergoing typeⅠ incision operation in-creased from 14.20% in 2006 to 92.30% in 2012;the rate of combined use of antimicrobial agents was relatively higher （7.00%-9.00%）in 2006-2009,had a downward trend in 2010- 2012,and decreased to 3.20% in 2012.Types of an-timicrobial agents for prophylactic use in typeⅠincision operation in 2006 and 2007 were similar to that of 2005,the main used antimicrobial agents were cephalosporins,penicillin and it’s compounds,and aminoglycosides;the major antimicrobial prophylaxis in 2008-2012 were the first and second generation cephalosporins,penicillin and it’s compounds.Multivariate non-conditional logistic regression analysis showed that age （40 - 59 years old）,departments （orthopedics,general surgery,and ophthalmology）,and years （2011 and 2012）were the main influencing factors for the qualified use of antimicrobial agents（all P〈0.05）.Conclusion Implementation of multiple intervention measures can improve the qualified rate of perioperative antimicrobial use in typeⅠ incision operation,reduce types of antimicrobial use and rate of combined antimicrobial use.