结直肠围术期抗菌药物管理项目的效果分析

Analysis of effect of perioperative antimicrobial stewardship program in colorectal surgery

目的总结抗菌药物管理项目(ASP)对结直肠手术围术期抗菌药物使用合理性和术后感染发生率的影响。方法根据首都医科大学附属北京友谊医院胃肠外科结直肠手术患者围术期抗菌药物使用情况,制定ASP干预方案,包括教育、制定临床路径、围术期抗菌药物医嘱实施干预等。选择该院2020年1月1日至12月31日接受结直肠手术且术前无感染的出院患者设为对照组,2021年同期同类患者设为干预组。比较两组患者抗菌药物使用的合理性和手术部位感染发生情况。结果对照组纳入患者525例,干预组纳入患者615例。结直肠手术部位感染发病率干预前后分别为4.27%和4.39%,两组比较差异无统计学意义(P>0.05);围手术期抗菌药物使用不合理比例分别为20.19%和5.85%,两组比较差异具有统计学意义(P>0.05)。干预前后两组患者抗菌药物使用强度比较,拉氧头孢下降55.19%(21.56比9.66),头孢曲松上升95.55%(8.53比16.68)。结论对结直肠手术患者,实施抗菌药物管理可提高抗菌药物使用合理性,且不会引起手术部位感染发生率增加。

Objective To summarize the effect of implementation of antimicrobial stewardship program(ASP)on the ratio⁃nality of antimicrobial use and the incidence of postoperative infection in colorectal surgery.Methods According to the periop⁃erative use of antibiotics in colorectal surgery patients in a tertiary hospital,ASP intervention measures were formulated,includ⁃ing education,formulation of clinical pathway,perioperative intervention of medication orders of antibiotics.Patients who re⁃ceived colorectal surgery from January 1 to December 31,2020,and without infection before operation were selected as the control group,and similar patients in 2021 were selected as the intervention group.The rationality of antimicrobial use and the incidence of surgical site infection(SSI)were compared between the two groups.Results Before and after the intervention,525 and 615 patients were enrolled respectively.The incidence of SSI in patients undergoing colorectal surgery before and after intervention were 4.27%and 4.39%respectively,with no significant difference.The rates of irrational antibiotics use before and after intervention were 20.19%and 5.85%respectively,with statistically significant difference.Comparison of antibiotics use densit(AUD)of antimicrobial agents in colorectal surgery before and after intervention showed that the AUD of latamoxef decreased by 55.19%(21.56 vs 9.66),and that of ceftriaxone increased by 95.55%(8.53 vs 16.68).Conclusion For pa⁃tients undergoing colorectal surgery,the implementation of ASP improves the appropriateness of antibiotics use,and doesn't in⁃crease the incidence of SSI.