某大型教学医院实施抗菌药物整治项目的效果分析

Effects of the antimicrobial management program in a large university hospital

目的探究某大型教学医院实施抗菌药物整治项目取得的效果,研究该项目对抗菌药物耐药性以及住院患者预后的影响。方法采用前后对照的方法,计算比较从2011年采取持续干预措施的前后(2009年1月—2010年12月、2012年1月—2016年12月)某大型教学医院(4 300张床位)住院患者的抗菌药物使用强度(antibiotics use density,AUD)及多重耐药菌的检出率,分析整治措施对抗菌药物耐药性及患者预后的影响。结果实施抗菌药物干预整治后住院患者AUD显著下降(P<0.001),金黄色葡萄球菌对苯唑西林的耐药率有所下降(P<0.001),而鲍曼不动杆菌(P<0.001)和肺炎克雷伯菌(P=0.011)对碳青霉烯耐药率增加;AUD与同期患者平均住院日无相关性(P=0.644),与患者病死率呈正相关性(r=0.932,P=0.001)。结论实施抗菌药物干预管理可明显减少抗菌药物的使用,不增加患者平均住院日和病死率,整治项目对该院细菌耐药性影响具有多样性,耐碳青霉烯的革兰阴性菌仍是住院患者健康的最大威胁,仍需联合多种感染防控措施持续干预。

Objective To investigate the effects of antimicrobial management program on inpatients outcomes and antimicrobial resistance among clinical isolates in a large-scaled university hospital. Methods The antibiotics use density(AUD) and antimicrobial resistance rate of multi-drug resistant bacteria before(from January 2009 to December2010) and after(from January 2012 to December 2016) the intervention of antimicrobial management program in a largescaled university hospital(4 300 beds) were calculated and compared, and the correlations of AUD with average length of hospital stay and mortality rate were analyzed. Results The AUD was significantly decreased after intervention(P0.001). The resistance rate of Staphylococcus aureus to oxacillin decreased(P0.001). Among Gram-negative bacteria,the resistance rates to carbapenems in Acinetobacter baumannii(P0.001) and Klebsiella pneumoniae increased(P=0.011).AUD was not correlated with the average length of hospital stay(P=0.644), while positively correlated with the in-hospital mortality rate(r=0.932, P=0.001). Conclusions The implementation of antimicrobial management program can significantly reduce the antimicrobial use and do not worsen patient outcomes in the hospital. The impact of the program on resistance varies significantly depending on both the bacterium and the agent, and carbapenem-non-susceptible Gramnegative bacilli emerges as a major threat. It is still necessary to combine other infection control measures.