综合性干预措施在碳青霉烯类药物管理中的作用研究

Role of comprehensive interventions in the management of carbapenems

目的分析综合性干预措施对碳青霉烯类药物使用的影响,探寻碳青霉烯类药物合理使用、降低耐碳青霉烯类细菌检出率的有效管理方法。方法回顾性分析2016年医院综合性干预措施实施前后76 995例患者碳青霉烯类药物DDDs、AUD及耐碳青霉烯类药物细菌检出率的变化情况,其中2016年1月1日-6月30日为干预前组,2016年7月1日-12月31日为干预后组。结果干预后抗菌药物DDDs为33754.85,与干预前34724.65比较,差异无统计学意义;碳青霉烯类药物DDDs与干预前比较下降,差异无统计学意义;干预后抗菌药物AUD及碳青霉烯类药物AUD分别由54.6、2.74降至50.66、1.53(P<0.05);干预后耐碳青霉烯类药物肠杆菌、铜绿假单胞菌、鲍氏不动杆菌分别从13.19%、53.29%、78.98%降至6.19%、38.28%、65.72%,差异有统计学意义(P<0.001)。结论采取多学科联合的综合性干预措施可显著降低碳青霉烯类药物AUD,减少耐碳青霉烯类药物细菌的检出率。

OBJECTIVE To explore the effective management methods for the rational use of carbapenems and the rate of carbapenem resistant bacteria through analyzing the effect of comprehensive interventions on the use of carbapenems.METHODS A total of 76995 patients during 2016 were retrospectively analyzed in the changes of carbapenems DDDs,AUD and carbapenem-resistant bacteria detection rate before and after comprehensive interventions.Patients from Jan.1,2016 to Jun.30,2016 were defined as before-intervention group,and from Jul.1,2016 to Dec.31,2016 were defined as after-intervention group.RESULTS After the implementation of the interventions,the median DDDs of antibiotics was 33754.85,compared with before the intervention （34724.65）,there was no significant difference.The DDDs of carbapenems after the implementation of interventions were lower than before,but the differences were not significant.The AUD of antibiotics and carbapenems were reduced from 54.6 and 2.74 to 50.66 and 1.53,respectively（P〈0.05）.The carbapenems-resistant Enterobacteriaceae,Pseudomonas aeruginosa and Acinetobacter baumannii also decreased from 13.19%,53.29% and 78.98% to 6.19%,38.28% and 65.72%,and the differences were significant（P〈0.05）.CONCLUSION Comprehensive interventions can significantly reduce the AUD of carbapenem and the incidence of carbapenem resistant bacteria.