抗菌药物在专项整治过程中清洁手术预防使用抗菌药物的调查

Investigation of prophylactic use of antibiotics for clean surgery during special rectification

目的了解医院在抗菌药物专项整治活动后的合理使用的情况及持续效果,为医院规范围术期预防使用抗菌药物及建立有效的干预措施提供参考。方法调查医院2016年1-7月全院清洁手术出院病历1 432份,对清洁手术预防性使用抗菌药物的使用率、用药品种选择规范率、抗菌药物使用频率与类别、术前给药时机符合率及预防用药总时间进行评价。结果 2016年1-7月某院妇产科、肝胆外科、骨科二病区、骨科一病区、普外科、乳腺外科、泌尿外科及脑外科清洁手术抗菌药物预防使用率分别为58.46%、16.22%、49.47%、55.90%、7.94%、16.22%、73.33%及76.47%,预防用药品种规范率分别为97.37%、72.22%、74.19%、75.93%、90.00%、91.67%、72.73%及96.15%,全院清洁手术抗菌药物预防使用率为41.55%,预防用药品种规范率为78.66%;2016年1-7月某院抗菌药物使用频率较高的为头孢菌素类,其中排名前三的为头孢呋辛占34.62%、头孢硫脒占33.45%及头孢他啶占18.66%,分别属于第二代、第一代与第三代头孢菌素;全院清洁手术术前给药时机在0.5-1h占总数的88.57%,其中24h停药率为14.12%,48h停药率为25.38%。结论清洁手术预防使用抗菌药物的给药时机情况较好,抗菌药物的使用率、品种的选择及使用疗程都存在一定的不合理性。

OBJECTIVE To observe the continuous effect of special rectification activities for antibiotics on reasonable use of antibiotics so as to provide guidance for reasonable prophylactic use of antibiotics during perioperative period and take effective intervention measures. METHODS From Jan 2016 to Jul 2016, a total of 1 432 medical records of clean surgeries were investigated. The rate of prophylactic use of antibiotics, rate of standard selection of antibiotic types, frequency and types of use of antibiotics, accordance rate of preoperative administration timing, and total time of antibiotics prophylaxis were evaluated. RESULTS From Jan 2016 to Jul 2016, the rate of prophy- lactic use of antibiotics for clean surgeries was 58.46 % in department of obstetrics and gynecology, 16.22 % in de- partment of hepatobiliary surgery, 49.47% in ward 2 of department of orthopedics, 55.90% in ward 1 of depart- ment of orthopedics, 7.9t~% in department of general surgery, 16.22% in department of hreast surgery, 73.33% in department of urotogy, 76. 47% in department of cerebral surgery. The rates of standard selection of antibiotic types were 97.37%, 72.22%, 74.19%, 75.93%, 90.00%, 91.67% 0, 72.73%, and 96.15%, respectively. The rate of prophylactic use of antibiotics for clean surgeries was 41.55 %, and the rate of standard selection of antibi- otic types was 78.66%. Cephalosporins were the high--frequency used antibiotics; cefuroxime, cefathiamidine, and ceftazidime ranked the top 3 places and respectively belonged to the second, first, and third generation cepha- losporins, accounting for 34.62%, 33.45%, and 18.66%, respectively. 88.57% of the clean surgeries chose the administration timing at 0. 5--1 hour before the surgeries, the 24h discontinuation rate was 14.12%, and the 48h withdrawal rate was 25.38%. CONCLUSION The administration timing of prophylactic antibiotics for clean surgeries is far to be good, ; the utilization rate of antibiotics, selection of antibiotic types, and treatment course are not reasonable.