我院多部门参与多重耐药菌感染防控工作的干预效果评价

Evaluation of Intervention Effect of Multi-department Participating in Prevention and Control of Multiresistant Bacteria Infection in Our Hospital

目的:为进一步推动医院抗菌药物合理应用及遏制细菌耐药提供参考。方法:对我院开展多部门参与多重耐药菌感染防控工作前后(2015年7月-2016年6月为干预前,2016年10月-2017年9月为干预后)患者住院期间抗菌药物的临床应用情况、抗菌药物使用前的微生物标本送检情况、多重耐药菌检出情况以及院内感染发生情况进行回顾性调查和对比分析,以评价该项工作的干预效果。结果:干预后,患者住院期间抗菌药物使用率、使用强度、联合使用率分别从64.15%、48.86 DDDs/(100人·d)、35.87%降至57.67%、36.58 DDDs/(100人·d)、11.47%(P<0.05),使用特殊使用级抗菌药物患者的降阶梯使用率、参照药敏试验结果的抗菌药物选择率分别从12.45%、48.28%升至56.63%、77.89%(P<0.001);使用非限制使用级、限制使用级、特殊使用级抗菌药物前的微生物标本送检率和总标本送检率以及使用抗菌药物前的无菌标本送检率分别从23.58%、43.15%、71.76%、36.37%、20.82%升至40.61%、58.43%、95.77%、51.33%、38.27%(P<0.05或P<0.01);耐甲氧西林金黄色葡萄球菌(MRSA)、耐碳青霉烯类肠杆菌科细菌(CRE)、多重耐药铜绿假单胞菌(MDR-PA)的检出率分别从4.43%、2.80%、1.99%降至1.36%、1.26%、0.80%(P<0.05或P<0.01),多重耐药菌检出率从16.21%降至10.68%(P<0.05);院内感染发生率从1.41%降至1.08%(P<0.05),且未再出现院内感染暴发的情况。结论:多部门参与多重耐药菌感染防控工作的效果显著,有助于促进抗菌药物合理应用和遏制细菌耐药,有必要作为一种长效管理机制持续运行下去。

OBJECTIVE：To provide reference for further promoting rational use of antibiotics in hospitals and curbing bacterial drug resistance. METHODS： Retrospective investigation and comparative analysis were made on the clinical application of antibiotics,the inspection of microbial specimens before use of antibiotics,the detection of multidrug-resistant bacteria,the occurrence of nosocomial infection before and after multi-sectoral participation in the prevention and control of multi-resistant bacteria infection in our hospital（from Jul. 2015 to Jun. 2016 as before intervention and from Oct. 2016 to Sept. 2017 as after intervention） in order to evaluate the intervention effect of this work. RESULTS：After intervention, the utilization rate of antibiotics,antibiotics use intensity and rate of combined use decreased from 64.15%,48.86 DDDs/hundred person per day,35.87% to 57.67%,36.58 DDDs/hundred person per day,11.47%,respectively（P〈0.05）. Both the de-escalation use rate of special grade antibiotics and the rate of antibiotics choice based on the drug sensitivity test increased from 12.45% and 48.28% to56.63% and 77.89%（P〈0.001）. Microbiological specimen inspection rate,total specimen inspection rate before using nonrestricted use,restricted use and special use antibiotics and the sterile specimen inspection rate before using antibiotics increased from 23.58%,43.15%,71.76%,36.37% and 20.82% to 40.61%,58.43%,95.77%,51.33% and 38.27%,respectively（P〈0.05 or P〈0.01）. The detection rate of MRSA,CRE and MDR-PA decreased from 4.43%,2.80%,1.99% to 1.36%,1.26%,0.80%,respectively（P〈0.05 or P〈0.01）,and the detection rates of multi-resistant bacteria decreased from 16.21% to 10.68%（P〈0.05）. Meanwhile,the incidence of nosocomial infection decreased from 1.41% to 1.08%（P〈0.05）,and there was no outbreak of nosocomial infection. CONCLUSIONS：The intervention effect of multi-department participation in prevention and control of multi-resistant bacterial infection is significant,which helps to promote rational use of antibiotics and curb bacterial drug resistance,and it is necessary to continue to operate as a long-term management mechanism.