临床药师干预前后双J管置入术围术期抗菌药物合理使用的效果评价

Effect of clinical pharmacists' intervention on the prophylactic use of antibiotics in double J tube implantation

目的评价临床药师干预前后双J管置入术围术期抗菌药物合理使用的效果。方法选取本院2016年9月至2017年2月行双J管置入术的患者124例为干预前组,2017年3-8月行该类手术的患者111例为干预组。临床药师按照泌尿外科国内外最新指南标准,结合卫计委抗菌药物指导原则作为依据,比较并分析干预前后两组患者合理使用抗菌药物的情况。结果干预前后未发现单剂量给药不合理或需要额外术中给药的患者。干预后,患者抗菌药物预防使用率、无指征使用抗菌药物的比例明显下降,且患者平均住院费用、平均药品费用、平均抗菌药物费用和全部药品费用占住院费用的比例均较干预前有所降低,差异均有统计学意义(P<0.05);而干预前后预防用药时机不合理、术后感染情况、抗菌药物占药品费用的比例比较,差异均无统计学意义(P>0.05)。结论通过临床药师的干预,泌尿外科双J管置入术患者预防用抗菌药物的使用比例显著降低,无指征用药情况较大改善,促进了围术期抗菌药物合理使用率的提高;同时纠正了围术期抗菌药物的品种选择,有效地降低了此类手术患者住院相关费用。但在预防用药时机和抗菌药物选择仍然存在一些问题,有待于进一步持续改进。

Objective To determine the effect of clinical pharmacists＇ intervention on the prophylactic use of antibiotics in double J tube implantation. Methods Totally 124 patients undergoing double J tube implantation were selected from our hospital from Sep. 2016 to Feb. 2017 as the pre-intervention group. Totally 111 patients undergoing double J tube implantation were selected from Mar. 2017 to Aug. 2017 as the post-intervention group. Clinical pharmacists intervened following the latest urological guidelines at home and abroad, and guidelines for clinical application of antimicrobial agents of the National Health and Family Planning Commission. The prophylactic use of antibiotics was compared between the 2 groups before and after the intervention. Results No unreasonable case of single dose or additional drug use during surgery was found before and after the intervention. After the intervention, utilization rate of antibiotics for prophylactic use, and the proportion of patients receiving antibiotics without indications were decreased significantly. In addition, the average hospitalization cost, average drug cost, average antibiotics cost and the proportion of total drug cost out of hospitalization cost were all decreased significantly compared to those before the intervention, with statistical significance （P 〈 0.05）. No statistical significance was found in the proportion of patients with unreasonable timing of initial prophylactic medication postoperative infection and the proportion of antibiotics cost out of hospitalization cost （P 〉 0.05）. Conclusion Clinical pharmacists＇ prophylactic use interventions significantly reduce prophylactic use of antibiotics in patients undergoing double J tube implantation, improve drug use without indications, and promote the rational utilization of antibiotics. The selection of antimicrobial agents in the perioperative period is corrected, and the cost of hospitalization for patients with such operations is effectively reduced.