某三级教学医院呼吸重症病房抗菌药物管理核查表的临床应用及评价

Evaluation and implementation of an antimicrobial stewardship checklist in a respiratory ICU ward in a tertiary teaching hospital

目的分析抗菌药物管理核查表实施前后呼吸监护室(RICU)抗菌药物的使用情况,探讨其临床价值。方法使用具有RICU特点的抗菌药物管理核查表,并回顾性分析蚌埠医学院第一附属医院2013年1月—2019年12月RICU所有患者的抗菌药物使用情况,将2013年1月—2015年12月实施核查表前的住院患者设为对照组,2017年1月—2019年12月实施核查表后的住院患者设为干预组,计算分析2组患者抗菌药物使用强度(AUD)、病原学送检、住院时间、好转率等信息。结果抗菌药物管理核查表实施后,对照组(329例)与干预组(550例)AUD值分别为207.51 DDD/(100人·d)和146.21 DDD/(100人·d),特殊级抗菌药物使用率分别为67.99%(223/328)和25.83%(124/480,χ^(2)=141.313,P<0.001),联合用药比例分别为94.82%(311/328)和65.21%(313/480,χ^(2)=97.132,P<0.001),抗菌药物使用前微生物送检率分别为92.68%(304/328)和97.50%(468/480,χ^(2)=10.621,P=0.001),住院时间由8(6,13)d降至8(5,12)d,差异有统计学意义(Z=-1.965,P=0.049)。结论实施抗菌药物管理核查表可以降低抗菌药物使用强度,减少联合用药及高级别抗菌药物使用,有助于规范抗菌药物应用,具有较高的临床应用价值。

Objective To analyse the consumption of antimicrobials in the respiratory intensive care unit(RICU)before and after the implementation of an antimicrobial stewardship checklist and evaluate the clinical application value of the antimicrobial stewardship checklist.Methods An antimicrobial stewardship checklist was designed according to RICU working practice.The antimicrobial-related data of all inpatients in the RICU of the First Affiliated Hospital of Bengbu Medical College from January 2013 to December 2019 were retrospectively analysed.Inpatients before the implementation of antimicrobial checklist management from January 2013 to December 2015 were set as the control group,and the remaining inpatients from January 2017 to December 2019,who were subject to antimicrobial checklist management,were set as the intervention group.The frequency of intensity of antibiotics use density(AUD),pathogenic test results,hospitalization improvement rate and length of RICU stay were calculated and analysed for both groups.Results After the implementation of the antimicrobial management checklist,the AUD values of the control group(n=329)and the intervention group(n=550)were 207.51 DDD/(100 people·day)and 146.21 DDD/(100 people·day),respectively.For the control group and the intervention group,the drug use rates were 67.99%(223/328)and 25.83%(124/480,χ^(2)=141.313,P<0.001),respectively;the combined drug ratios were 94.82%(311/328)and 65.21%(313/480,χ^(2)=97.132,P<0.001),respectively;and the rates of microbial testing before antimicrobial use were 92.68%(304/328)and 97.50%(468/480,χ^(2)=10.621,P=0.001),respectively.The length of hospital stay decreased from 8(6,13)days to 8(5,12)days,and the difference was statistically significant(Z=-1.965,P=0.049).Conclusion The implementation of an antimicrobial stewardship checklist can help in reducing the intensity of antimicrobial drug use and reduce the frequency of combined use and high-grade use of antimicrobials,which is helpful to standardise the antimicrobial application and has high value in clinical application.