后路腰椎手术患者实施抗菌药物管理项目的效果评价

Effect Evaluation of the Antimicrobial Stewardship Program on Patients Undergoing Posterior Lumbar Surgery

目的评价抗菌药物管理项目(antimicrobial stewardship program,ASP)对后路腰椎手术患者的临床结局及抗感染治疗费用的影响。方法回顾性分析2016~2019年于我院骨科行后路腰椎手术并被反馈ASP建议的病例。比较采纳ASP建议与否对患者目标药物治疗天数、住院天数、目标药物费用及抗菌药物总费用、患者30 d感染相关再住院率的影响。结果2016~2019年,ASP小组共反馈临床建议113例,临床采纳ASP建议54例,拒绝ASP建议59例,采纳率47.79%。采纳ASP建议可以显著减少患者目标药物使用天数(5.0 d vs 6.0 d,P<0.001)及费用(1559.50元vs 2300.27元,P<0.01),同时可以降低患者住院天数(15.5 d vs 17.0 d,P=0.174)及抗菌药物总费用(4144.96元vs 5218.53元,P=0.079)。采纳组与拒绝组患者的30 d感染相关再住院率分别为0 d及1.69%。结论采纳ASP建议可在不增加感染相关事件的情况下,显著降低后路腰椎手术患者目标药物使用天数及费用,值得在骨科手术的抗菌药物管理中进一步研究。

OBJECTIVE To evaluate the effect of antimicrobial stewardship program(ASP)on clinical outcome and expense of anti-bacterial drug in patients undergoing posterior lumbar surgery.METHODS A retrospective research was performed among the patients who underwent posterior lumbar surgery in the orthopedic ward from January 2016 to December 2019 by the intervened ASP database.Duration of therapy with targeted drug,length of hospital stays,30-day infection-related readmission rate,expense of targeted drug and all antibacterial drugs were compared between interventions accepted and rejected groups.RESULTS Totally 113 interventions were recommended by ASP team and acceptance rate was 47.79%.There were 54 cases in the accepted group and 59 in the rejected group.In comparison with the rejected group,the shorter therapy day of targeted drug(5.0 d vs 6.0 d,P<0.001)and less expense of targeted drugs(1559.50 yuan vs 2300.27 yuan,P<0.01)were showed in the accepted group,while shorter length of hospital stays(15.5 d vs 17.0 d,P=0.174)and less expense of total antibacterial drugs(4144.96 yuan vs 5218.53 yuan,P=0.079)were also observed in the accepted group.The 30-day infection-related readmission rate was 0 and 1.69%in accepted group and rejected group.CONCLUSION The adoption of recommendation by the ASP team is associated with a reduction in the therapy days and cost of targeted drugs without increasing of postoperative re-infection,which is worthy of further research in orthopedic surgery.