抗菌药物导向计划对医生抗菌药物处方行为的影响

Impact of antimicrobial stewardship program on doctor's antimicrobial drug prescription

目的评价抗菌药物导向计划(ASP)对医生抗菌药物处方行为的影响。方法选择2018年1月1日~12月31日未制定抗菌药物导向计划(ASP)时住院并接受抗菌药物治疗的150例成人社区获得性肺炎(CAP)患者作为对照组,2020年1月1日~12月31日制定ASP并在项目完善推行后住院并接受抗菌药物治疗的150例成人CAP患者作为观察组。比较两组患者的住院时间、抗菌药物使用时间、前6位使用率较高的抗菌药物品种及费用、联合用药率、抗菌药物使用强度、微生物检验样本送检率和不合理用药率,从而了解ASP对医生抗菌药物处方行为的影响。结果两组患者性别、年龄比较差异具有统计学意义(P<0.05)。两组患者使用例次最多的前6位抗菌药物分别是左氧氟沙星,使用例次255次;头孢曲松钠,使用例次142次;美洛西林钠舒巴坦钠,使用例次120次;头孢呋辛钠,使用例次89次;头孢唑林钠,使用例次34次;阿奇霉素,使用例次20次。观察组患者住院时间(7.15±2.55)d、抗菌药物使用时间(6.80±2.31)d短于对照组的(9.17±3.35)、(8.47±2.97)d,抗菌药物使用费用530.50(330.00,691.75)元少于对照组的806.50(568.75,1183.50)元,差异具有统计学意义(P<0.05)。观察组患者抗菌药物使用强度为90.13,低于对照组的105.66。观察组抗菌药物单联用药率94.00%、微生物检验样本送检率94.67%高于对照组的55.33%、62.00%,抗菌药物二联用药率6.00%、不合理用药率4.67%低于对照组的44.67%、38.00%,差异具有统计学意义(P<0.05)。结论实施ASP,有利于减少患者住院时间、抗菌药物使用时间、平均抗菌药物费用、抗菌药物二联用药、不合理用药情况,有效降低抗菌药物使用强度,提高微生物检验样本送检率,改善医生抗菌药物处方行为。

Objective To evaluate the impact of antimicrobial stewardship program(ASP)on doctor's antimicrobial drug prescription.Methods A total of 150 adult patients with community-acquired pneumonia(CAP)who were hospitalized and received antibiotics from January 1 to December 31,2018 when no ASP was implemented were selected as the control group.A total of 150 adult patients with CAP who were hospitalized and received antimicrobial drugs from January 1,2020 to December 31,2020 after the implementation of ASP were selected as the observation group.The duration of hospitalization,duration of antimicrobial drug use,the top 6 antimicrobial drug species with high utilization rate and their cost,the rate of combined drug use,the antibiotics use density,the submission rate of microbiological test sample,and the rate of irrational drug use were compared between the two groups to understand the impact of ASP on physicians'antimicrobial prescription.Results The differences in gender and age between the two groups were statistically significant(P<0.05).The top 6 most used antimicrobial drugs in both groups were levofloxacin,255 cases/times;ceftriaxone sodium,142 cases/times;meloxicillin sodium and sulbactam sodium,120 cases/times;cefuroxime sodium,89 cases/times;cefazolin sodium,34 cases/times;and azithromycin,20 cases/times.The duration of hospitalization and duration of antimicrobial drug use in the observation group were(7.15±2.55)and 6.80±2.31)d,which were shorter than those of(9.17±3.35)and(8.47±2.97)d in the control group;the cost of antimicrobial drugs in the observation group was 530.50(330.00,691.75)yuan,which was less than that of 806.50(568.75,1183.50)yuan in the control group;the differences were statistically significant(P<0.05).The antibiotics use density in the observation group was 90.13,which was lower than that of 105.66 in the control group.The rate of single antimicrobial drug of 94.00%and the submission rate of microbiological test sample of 94.67%in the observation group were higher than those of 55.33%and 62.00%in the control group;the rate of double combination of antimicrobial drugs of 6.00%and the rate of irrational drug use of 4.67%in the observation group were lower than those of 44.67%and 38.00%in the control group;the differences were statistically significant(P<0.05).Conclusion The implementation of ASP is beneficial to reduce the duration of hospitalization,the duration of antimicrobial drug use,the average cost of antimicrobial drugs,the combination of antibiotics and irrational drug use,effectively reduce the antibiotics use density,improve the submission rate of microbial test sample,and improve the doctor's antimicrobial drug prescription.