某三甲医院围手术期预防性使用抗菌药物的干预及效果

Intervention and efficacy of antimicrobial prophylaxis in a tertiary firstclass hospital during peri-operative period

目的探讨科学有效的合理使用抗菌药物的干预方法,为提高抗菌药物预防性使用的合理率提供参考依据。方法选取2011年1—12月及2016年1—12月出院的Ⅰ类切口手术患者为研究对象,2011年为干预前组,2016年为干预后组。制定干预方案,并监测和比较干预前后两组Ⅰ类切口手术患者抗菌药物预防性使用率及合理率。结果干预前后两组分别监测Ⅰ类切口手术患者1 027、3 820例。2012年1月起对围手术期抗菌药物预防性合理使用采取综合干预措施,干预后抗菌药物预防性使用率Ⅰ类切口手术患者由97.18%(998/1 027)下降至21.23%(811/3 820),"7类"手术患者由96.33%(210/218)下降至1.88%(25/1 330);抗菌药物品种选择合理率由21.14%上升至99.38%;用药时机合理率由76.05%上升至99.01%;疗程合理率由23.95%上升至99.06%;联合用药率由12.73%降低至0;术中追加药物合理率由11.72%上升至95.18%;干预前后两组比较,差异均有统计学意义(均P<0.01)。Ⅰ类切口手术患者SSI发病率干预前为0.32%,干预后为0.61%,差异无统计学意义(χ2=0.75,P=0.54)。结论有效的干预使围手术期预防性抗菌药物的使用逐步规范,符合国家相关要求。

Objective To explore scientific and effective intervention method for rational use of antimicrobial agents,and provide reference for improving rational rate of antimicrobial prophylaxis.Methods Patients who received class I incision operation and discharged from hospital in January-December 2011(pre-intervention group)and January-December 2016(post-intervention group)were selected as studied subjects.Intervention program was formulated,use rate and rational rate of antimicrobial prophylaxis between two groups of patients receiving class I incision operation were monitored and compared before and after intervention.Results Before and after intervention,1 027 and 3 820 cases of class I incision operation in two groups of patients were monitored respectively.Since January 2012,comprehensive intervention measures for rational use of antimicrobial prophylaxis has been adopted,after intervention,prophylactic antimicrobial use rate in patients undergoing class I incision operation decreased from 97.18%(998/1 027)to 21.23%(811/3 820),prophylactic antimicrobial use rate in seven types of operation patients dropped from 96.33%(210/218)to 1.88%(25/1 330);rational rate of antimicrobial agent selection rose from 21.14%to 99.38%;rational rate of antimicrobial use time rose from 76.05%to 99.01%;rational rate of treatment course increased from 23.95%to 99.06%;combined antimicrobial use rate decreased from 12.73%to 0;rational rate of supplemental antimicrobial agents during operation increased from 11.72%to 95.18%;difference between two groups before and after intervention were all statistically significant(all P<0.01).Incidence of SSI before and after intervention were 0.32%and 0.61%respectively,difference was not significant(χ2=0.75,P=0.54).Conclusion Effective intervention can standardize antimicrobial prophylaxis during peri-operative period,meets the relevant requirements of national standards.