复旦大学附属妇产科医院执行《抗菌药物临床应用指导原则(2015年版)》前后住院患者抗菌药物应用对比分析

Comparison on Application of Antibiotics in Obstetrics and Gynecology Hospital of Fudan University Before and After the Implementation of the Guiding Principles of Clinical Application of Antibiotics(Edition 2015)

目的:了解《抗菌药物临床应用指导原则(2015年版)》(以下简称"新版指导原则")执行前后共6年妇产科专科医院住院患者抗菌药物整体使用情况,并重点分析妇科病房和产科病房抗菌药物应用的变化.方法:回顾性分析复旦大学附属妇产科医院(以下简称"我院")在"新版指导原则"执行前(2013—2015年)和执行后(2016—2018年)住院患者抗菌药物整体使用情况,并对比分析妇科和产科病房在"新版指导原则"执行前(2015年1—4月)和执行后(2016年1—4月)围术期抗菌药物使用变化情况,采用SPSS 19.0软件进行数据统计分析.结果:"新版指导原则"执行后,我院住院患者Ⅰ类切口手术围术期抗菌药物预防性使用率由执行前的16.91%降至10.69%,抗菌药物使用率由45.29%降至35.34%、抗菌药物使用强度由36.88 DDDs/(100人·d)降至32.55 DDDs/(100人·d);妇科病房Ⅰ类切口手术围术期抗菌药物预防性使用率由24.29%降至19.49%,妇科和产科病房抗菌药物使用率分别由70.66%、73.10%降至63.12%、66.67%,抗菌药物使用强度分别由82.62、26.39 DDDs/(100人·d)降至73.06、25.13 DDDs/(100人·d);妇科和产科病房围术期预防性应用抗菌药物的品种选择、用药时间及用药疗程均有不同程度好转.结论:"新版指导原则"的执行,在很大程度上降低了我院Ⅰ类切口手术抗菌药物使用率、抗菌药物使用率和使用强度,规范了围术期抗菌药物预防性应用的品种和用药疗程,对改进我院围术期预防用药是有效的,且不增加患者术后部位感染概率.

OBJECTIVE:To investigate the application of antibiotics in obstetrics and gynecology hospital before and after six-year implementation of the Guiding Principles of Clinical Application of Antibacterials(Edition 2015)(hereinafter referred to as“New Guiding Principles”),and to analyze the changes of application of antibiotics in gynecology ward and obstetrics ward.METHODS:To retrospectively analyze the general application of antibiotics before(during 2013-2015)and after(during 2016-2018)the implementation of“New Guiding Principles”in the Obstetrics and Gynecology Hospital of Fudan University(hereinafter referred to as“our hospital”),and to compare the changes of perioperative application of antibiotics in gynecology ward and obstetric ward before(from Jan.to Apr.2015)and after(from Jan.to Apr.2016)the implementation of“New Guiding Principles”,SPSS 19.0 was adopted for data analysis.RESULTS:After the implementation of“New Guiding Principles”,the usage rate of antibiotics for typeⅠincision had decreased from 16.91%to 10.69%,the usage rate of antibiotics had decreased from 45.29%to 35.34%,and the use intensity of antibiotics had decreased from 36.88 DDDs/(100 persons·d)to 32.55 DDDs/(100 persons·d);the usage rate of antibiotics for typeⅠincision in gynecological ward had decreased from 24.29%to 19.49%,the usage rate of antibiotics in gynecological ward and obstetric ward had respectively decreased from 70.66%and 73.10%to 63.12%and 66.67%,the use intensity of antibiotics had respectively decreased from 82.62 DDDs/(100 persons·d)and 26.39 DDDs/(100 persons·d)to 73.06 DDDs/(100 persons·d)and 25.13 DDDs/(100 persons·d);the variety selection,medication time and treatment course of prophylactic application of antibiotics in gynecological ward and obstetric ward during perioperative period had been improved at varying degrees.CONCLUSIONS:The implementation of“New Guiding Principles”has effectively lower then usage rate of antibiotics for typeⅠincision,the usage rate and use intensity of antibiotics,standardized the variety selection and treatment course of prophylactic application of antibiotics during perioperative period,improve prophylactic drug application in our hospital,and without increasing the probability of postoperative infections.