我院碳青霉烯类抗菌药物专档管理体系的构建与实践

Construction and Practice of Special Management System for Carbapenems in Our Hospital

目的:构建碳青霉烯类抗菌药物专档管理体系,规范该类抗菌药物的临床合理应用。方法:根据国家卫生健康委相关文件要求,构建中国科学技术大学附属第一医院(以下简称"我院")碳青霉烯类抗菌药物专项管理体系,并对管理前后抗菌药物使用强度、处方合理率和耐碳青霉烯类肠杆菌检出率进行分析。结果:我院构建的碳青霉烯类抗菌药物专档管理体系包括组织建设、专档管理信息化建设、专档管理药品处方审核、处方点评干预等方面。实施专档管理体系后我院碳青霉烯类抗菌药物的使用强度由实施前的2.78下降到2.03;处方合理率由62.8%上升至98.3%(P<0.05);耐亚胺培南鲍曼不动杆菌、大肠埃希菌和铜绿假单胞菌的检出率从91.4%、2.4%、49.5%下降至79.7%、1.6%、39.7%,但耐亚胺培南肺炎克雷伯菌检出率从34.4%上升至50.0%。结论:我院碳青霉烯类抗菌药物专档管理体系在实践中取得了一定的成效,有助于减少该类药物的滥用现象并提升合理用药水平,降低耐药菌检出率;同时,临床应加强对耐亚胺培南肺炎克雷伯菌的院感控制。

OBJECTIVE:To establish a special management system of carbapenems,and to standardize the clinical and rational application of carbapenem antibacterial drugs.METHODS:According to the requirements of the relevant documents of National Health Commission of the People’s Republic of China,the special management system of carbapenems in the First Affiliated Hospital of University of Science and Technology of China(called"our hospital"in short)was constructed.The use intensity,reasonable rate of prescription and the detection rate of carbapenem resistant Enterobacteriaceae were analyzed before and after management.RESULTS:The special management system of carbapenems in our hospital included organization construction,information construction of special management,prescription review of special management drugs,prescription comment intervention and so on.After the implementation of the special management system,the intensity of carbapenems use decreased from 2.78 to 2.03,the reasonable rate of prescription increased from 62.8%to 98.3%(P<0.05).The detection rates of Acinetobacter baumannii,Escherichia coli and Pseudomonas aeruginosa resistance to carbapenems decreased from 91.4%,2.4%,49.5%to 79.7%,1.6%,39.7%,respectively.However,the detection rate of Klebsiella pneumoniae resistance to imipenem increased from 34.4%to 50.0%.CONCLUSIONS:The special management system of carbapenems in our hospital has achieved some results in practice,which helps to reduce the abuse of these drugs and improve the reasonable level of drug use and reduce the detection rate of drug-resistant bacteria.At the same time,hospital infection control of K.pneumoniae resistance to imipenem should be strengthened.