抗菌药物管理项目实施对经尿道膀胱肿瘤切除术患者的效果评价

Evaluation of the effect of antimicrobial stewardship program in patients undergoing transurethral resection of bladder tumor

目的探讨抗菌药物管理项目(ASP)实施对经尿道膀胱肿瘤切除术(TURBT)患者的效果。方法开展回顾性队列研究,将2014年7月至2015年12月(ASP干预前)和2018年7月至2019年12月(ASP干预后)北京协和医院泌尿外科行TURBT的住院患者分别设为对照组和研究组。比较两组患者在术后住院期间泌尿系感染发生率、30 d因泌尿系感染门急诊就诊率以及手术预防用抗菌药物选择及使用时间的合理率。结果共纳入患者708例,对照组264例,研究组444例。对照组和研究组的手术预防用抗菌药物选择的合理率分别为72.35%和92.34%,差异有统计学意义(P<0.001)。对照组和研究组患者手术用抗菌药物使用时间合理率分别为65.53%和59.23%(P=0.096),住院期间术后泌尿系感染发生率分别为0.76%和0.23%(P=0.648),术后30 d内患者因泌尿系感染的门急诊就诊率分别为7.98%和7.23%(P=0.767),差异均无统计学意义。结论实施ASP可提高TURBT患者手术预防用抗菌药物选择的合理率,且不增加术后院内泌尿系感染发生。

Objective To evaluate the effect of antimicrobial stewardship program(ASP)in patients undergoing transurethral resection of bladder tumor(TURBT).Methods A retrospective cohort study was carried out.The inpatients who underwent TURBT in the Department of Urology Peking Union Medical College Hospital from July 2014 to December 2015(before ASP intervention)and from July 2018 to December 2019(after ASP intervention)were divided into control group and study group respectively.The incidence rate of urinary tract infection during postoperative hospitalization,the outpatient/emergency rate within 30 days due to urinary tract infection,and the rational rate of antibiotic selection for surgical prophylaxis were compared between the two groups.Results A total of 708 patients were included,264 cases in the control group and 444 in the study group.The rational selection rate of antibiotics for surgical prophylaxis in the control group and the study group was 72.35%and 92.34%respectively,with statistically significant difference(P<0.001).The reasonable rate of duration of surgical antibacterial drugs was 65.53%and 59.23%in the two groups respectively(P=0.096).The incidence of postoperative urinary tract infection in the control group and the study group during hospitalization was 0.76%and 0.23%respectively(P=0.648).The outpatient/emergency rates of patients with urinary tract infection within 30 days after surgery were 7.98%and 7.23%respectively(P=0.767),with no statistically significant difference.Conclusion ASP can improve the reasonable selection rate of prophylactic antibiotics in TURBT without affecting the postoperative urinary tract infection rate in hospital.