山西地区15家医院抗菌药物使用及耐药的断面时点流行病学调查

Antimicrobial consumption and resistance in 15 hospitals inpatients in Shanxi province:Results of a point prevalence survey

目的调查并分析山西地区抗菌药物使用、耐药和院感情况,以期为细化抗菌药物管理和耐药控制制定相关干预策略提供依据。方法调查对象为山西省11个地市共15家三级甲等综合医院,采用全球-断面时点流行病学调查(point prevalence survey,PPS)方法收集各医院患者抗菌药物使用、医院获得性感染(hospital acquired infection,HAI)和细菌分离及耐药情况,采用logistics多因素回归模型分析HAI的危险因素。结果被调查的15家医院共6664名患者计入。抗菌药物使用率为30.06%,单一用药占比为67.20%,联合用药占比为32.80%,其中呼吸科抗菌药物使用率及联合用药占比最高,分别为72.97%和44.27%,均高于ICU的66.54%和40.22%。感染类型以社区感染(community acquired infection,CAI)为主,占91.59%;治疗CAI经验性用药的比例为89.96%,高于HAI的67.17%。肺炎或下呼吸道感染比率最高37.46%,其次是胃肠感染11.54%。调查当日,抗菌药物医嘱应用前3位分别为左氧氟沙星、头孢他啶和依替米星。1259例手术患者,手术类型以Ⅱ类切口最多占51.72%,第二代头孢菌素头孢呋辛钠为手术预防用药的主要药物;术后预防用药疗程大于1 d的比例为67.43%。发生医院获得性感染的多因素分析结果显示,疾病类型、入院前住院史、入住重症医学科为HAI的独立危险因素(P<0.05)。微生物种类前5位为革兰阴性菌,肠杆科细菌耐碳青霉烯类的比率为10%。结论被调查各医院之间抗菌药物使用存在差别,整体呼吸系统抗菌药物使用率及联合用药率较高,手术预防用抗菌药物术后疗程偏长,需制定相应的管理措施进行干预。

Objective This research was conducted to investigate and analyze antimicrobial use,resistance and hospital-acquired infections in areas of Shanxi province,providing the basis for the development of interventions to refine antimicrobial management and resistance control.Methods A total of 15 grade A tertiary-level general hospitals in 11 cities of Shanxi province were surveyed.The use of antimicrobial,hospital-acquired infection(HAI),isolation of bacterial strain,and antimicrobial resistance of patients in each hospital were collected using the global-PPS(point prevalence survey)method.In addition,the risk factors of HAI were analyzed by multinomial logistic regression.Results A total of 6664 patients from the 15 hospitals in the province were investigated.The rate of antimicrobial use was 30.06%and 67.25%for a single drug.Among them,respiratory department had the highest rate of antimicrobial use and combination use with 72.97%and 44.27%,which were higher than 66.54%and 40.22%in the ICU.The main type of infection was community-acquired infection(CAI,91.59%),and the proportion of empirical medication for CAI was 89.96%,which was higher than that for HAI(67.17%).The highest infection rate of pneumonia or lower respiratory tract was 37.46%,followed by gastrointestinal infections at 11.54%.On the day of the survey,the top three antimicrobial prescriptions were levofloxacin,ceftazidime,and etimicin.Type II was the largest number of surgical incision for the 1259 patients who underwent surgery,accounting for 51.72%.Cefuroxime is the main drug for surgical prophylaxis.Moreover,the proportion of postoperative prophylactic medication courses more than 1 day was 67.43%.The results of multivariate analysis showed that disease type,history of hospitalization before admission,and admission to intensive care unit were independent risk factors for HAI.The top five were all G-bacteria in the isolated strains,and the rate of carbapenem resistance in Enterobacteriaceae was 10%.Conclusion There are differences in the use of antimicrobial among hospitals.The respiratory system has a high rate of antimicrobial use and combination use,and the postoperative course of antimicrobial for surgical prophylaxis is long,therefore,corresponding management measures should be developed for intervention.