抗菌药物管理协作干预改进白内障手术围术期预防用药合理性效果评价

Antimicrobial Stewardship Improving the Rational Use of Prophylactic Drugs in Perioperative Period of Cataract Surgery

目的探讨抗菌药物管理(AMS)协作干预促进白内障手术围术期合理预防使用抗菌药物的效果。方法随机抽取医院2017年7月至12月(干预前)和2018年1月至6月(干预后)行白内障超声乳化抽吸术+人工晶体置入术的患者各50例。比较干预前后全身及局部用抗菌药物使用情况,包括抗菌药物使用率、品种选择、用药时机和用药疗程,以及干预前后患者的抗菌药物费用、住院时间与住院费用。结果干预前后全身性预防用药均选择罗红霉素胶囊口服,遴选药物不适宜;干预后全身性预防用药使用率由100. 00%降至18. 00%;给药时机、给药疗程合理率分别由74. 00%,66. 00%提高至100. 00%;干预前后局部滴眼液均存在重复用药现象;干预后联合用药情况较干预前明显改善;干预前后两组住院时间无显著差异,干预后抗菌药物费用和住院费用均显著减少(P <0. 05)。结论 AMS协作干预可有效改进白内障手术围术期使用抗菌药物的合理性。

Objective To investigate the effect of antimicrobial stewardship(AMS)on improving the rational use of prophylactic drugs in perioperative period of cataract surgery.Methods Patients who underwent cataract phacoemulsification+intraocular lens(IOL)implantation from July to December 2017(before intervention)and January to June 2018(after intervention)were randomly selected,50 cases in each group.The use of systemic and local antibiotics was compared before and after the intervention,including the use rate of antibiotics,the choice of varieties,administration time,treatment course of prophylactic application of antibiotic.The cost of antibacterial,length of stay and hospitalization expenses were compared before and after intervention.Results Roxithromycin capsule selected as systemic prophylactic drug before and after intervention was not suitable.After intervention,the use rate of systemic prophylactic drugs decreased from 100.00%to 18.00%.The rational rate of administration timing and administration duration both increased from 74.00%and 66.00%to 100.00%,respectively.There was a lot of reuse of local-eye drops before and after the intervention;the situation of combined medication improved obviously after the intervention.There was no significant difference in hospitalization time between before and after the intervention,but the cost of antibiotics and hospitalization decreased significantly after intervention(P<0.05).Conclusion AMS collaborative intervention can effectively improve the rational use of prophylactic drugs in perioperative period of cataract surgery.