基于抗菌药物分级管理的我院抗菌药物医嘱评价

The Comments of Antimicrobial Medical Orders Based on Antimicrobial Level-to-level Management in Our Hospital

目的:明确我院三级抗菌药物(非限制使用级、限制使用级、特殊使用级)不合理使用情况的特点及差异,为临床规范使用抗菌药物提供理论依据。方法:对我院736份出院病历的1 228条抗菌药物医嘱逐条进行合理性点评,并对三级抗菌药物医嘱不合理使用率、分布特点、类型进行比较。结果:我院三级抗菌药物不合理使用率差异不全相同,以限制使用级为最高(25.0%),特殊使用级最低(9.8%),两者比较差异有统计学意义(P<0.01)。以头孢菌素为主的β内酰胺类抗菌药物的不合理医嘱最多。三级抗菌药物不合理用药类型差异有统计学意义(P<0.05)。"抗菌药物用法用量不适宜"、"围手术期预防性使用抗菌药物不合理"为非限制使用级及限制使用级抗菌药物的主要不合理医嘱构成。而"遴选抗菌药物不适宜"则为特殊使用级抗菌药物的主要不合理医嘱构成。结论:我院抗菌药物不合理使用情况较普遍。医院需针对各级抗菌药物使用中存在的主要问题加强抗菌药物的管理。

Objective： To clarify the differences and features of unreasonable use of antimicrobial agents of the three levels（ the non-restrictive use level,the restrictive use level and the special use level） in our hospital,in order to provide theoretical basis for clinical rational use of antibiotics. Methods： The comments on the 1 228 antimicrobial medical orders of 736 discharged patients of our hospital were carried out in the article. And the proportions,distribution characteristics and types of irrational medical orders were compared and analyzed. Results： The irrational rates of antimicrobial usage of the three levels in our hospital were different,with the restrictive use level of which was highest（ 25. 0%）,whilst the special use level the lowest（ 9. 8%）. The two groups had remarkable statistical significance（ P〈0. 01）. Also,betalactam antibiotics,dominated by cephalosporins,was the principal component of the non-rational use of antibacterial medical orders of the three levels. In addition,the proportions of all the types of irrational antibacterial medical orders had the remarkable difference（ P〈0. 05）. And for the antimicrobial agents of the non-restrictive use level and the restrictive use level,the both two styles of ＂Improper antibacterial drug dosage and administration＂and ＂Incorrect antimicrobial prophylaxis for the prevention of surgical site infection＂accounted for the most of the types of the irrational medical orders. As for the antimicrobial agents of the special use level,＂Inappropriate selection of antimicrobial agents＂was the main type. Conclusion： Irrational use of antimicrobial agents is still common in our hospital. So the hospital should enhance antimicrobial stewardship according to the problems which were found in the antibacterial treatment of the three levels.