山西某三甲医院抗菌药物使用断面时点流行病学调查

Point Prevalence Epidemiological Survey of Antimicrobial Drug Use in a GradeⅢ-A Hospital of Shanxi Province

目的调查某三甲医院住院患者抗菌药物使用情况,分析院内感染的危险因素。方法采用断面时点流行病学调查14个科室在2020年7月15日8:00的抗菌药物使用情况,采用二元Logistic回归模型分析医院获得性感染的危险因素。结果共纳入住院患者477例,共246条医嘱,针对社区获得性感染的患者展开治疗的198例,占80.49%(198/246);针对医院获得性感染和社区获得性感染患者展开治疗时,多采取经验性用药形式,其中前者占77.78%,后者占71.43%,无明显差异(P=1.000);35.43%的感染在开展治疗期间,至少用了1种抗菌药物;就联合用药而言,内科病房占13.17%,外科病房占16.13%。手术预防性应用抗菌药物共39例,Ⅰ类切口预防用抗菌药物的疗程大于1 d的占45.24%,低于同级别医院;多因素分析显示,入住ICU是调查当日发生医院获得性感染的唯一危险因素(P<0.001)。结论在外科重视抗菌药物的联用,并在围术期合理、预防性应用抗菌药物,以加大对医院感染事件的高危人群(重症医学科)的目标性防控工作。同时加强外科医师合理使用抗菌药物的培训,促进抗菌药物的合理使用。

Objective To investigate the use of antimicrobial drug in patients of a gradeⅢ-A hospital and analyze the risk factors of nosocomial infection.Methods The use of antimicrobial drug in fourteen departments at 8:00 was investigated by cross-sectional time point epidemiology on the 15th of July,2020,and the risk factors of hospital acquired infection were analyzed by binary logistic regression model.Results A total of 477 inpatients were included,with 246 medical orders.A total of 198 patients were treated for community acquired infections,accounting for 80.49%(198/246).Patients with hospital acquired infection and community acquired infection were often treated with empirical medication,of which the former accounted for 77.78%,the latter accounted for 71.43%,there was no significant difference(P=1.000).Precisely 35.43%of infections were treated with at least one antibacterial drug.In terms of combined drug use,the internal medicine ward accounted for 13.17%,the surgical ward accounted for 16.13%.There were 39 cases of prophylactic use of antimicrobial drug in surgery,the course of treatment of prophylactic use of antimicrobial drug for ClassⅠincision was more than one day accounted for 45.24%,which was lower than that of hospitals in the same level.Multivariate analysis showed that admission to intensive care unit(ICU)was the only risk factor for hospital acquired infection on the day of survey(P<0.001).Conclusion We should attach importance to the combined use of antimicrobial drug in surgery,and use them reasonably and prophylactically during the perioperative period,so as to increase the targeted prevention and control of high-risk groups of hospital infection(Department of Severe Medicine).Meanwhile,we should strengthen the training of surgeons on the rational use of antimicrobial drug to promote the rational use of antimicrobial drug.