临床药师主导的头孢菌素皮试规范化管理项目的效果评价——规范头孢菌素原液皮试的干预研究(三)

Effect evaluation of de-adoption of routine skin test for cephalosporin prescribing program led by clinical pharmacists——Intervention study on de-adoption of routine skin test for cephalosporin prescribing(PARTⅢ)

目的:评价在《β内酰胺类抗菌药物皮肤试验指导原则(2021年版)》发布后,北京大学第三医院临床药师为主导的抗菌药物管理(antimicrobical stewardship,AMS)团队实施了一系列取消头孢菌素皮试措施的干预效果。方法:回顾性分析2020年5月至2022年5月该院头孢菌素皮试临床应用的相关数据以及药品不良反应发生情况。临床药师首先进行基线调研,发现主要影响因素,着重进行管理,然后分别从头孢菌素皮试例次、皮试率和消耗量进行分析,同时采用中断时间序列分析(ITS)方法,临床药师在干预前(2020年5月至2021年5月)和干预后(2021年6月至2022年5月)对头孢菌素使用强度进行分析。结果:规范头孢菌素皮试后,结局指标皮试例次、皮试率、消耗量均显著下降,在85%~89%之间(P<0.05)。干预前,头孢菌素使用强度每月下降22.83%(P=0.002),在干预的第1个月(2021年6月),头孢菌素使用强度上升了82.52%(P=0.267),而相较于干预前的趋势,干预后的变化趋势在-22.83%的基础上再上升54.42%(P<0.001)。同时2021年与2020年同期相比,总的抗菌药物使用强度下降。不良反应发生率差异无统计学意义。结论:通过规范化管理,头孢菌素的皮试例次、皮试率和消耗量均显著下降,在总的抗菌药物使用强度下降的同时头孢菌素使用强度较之前大幅上升,在一定程度上优化了抗菌药物临床使用结构,不良反应发生率并未增加,以临床药师主导的头孢菌素皮试规范化管理项目取得了较好的成效。

OBJECTIVE To evaluate the efficacy of a series of interventions to cancel cephalosporin skin test implemented by the clinical pharmacist-led antimicrobical stewardship(AMS)team following the release of the Guiding Principles for Skin Testing of beta-lactam Antimicrobials(2021 Edition).METHODS The relevant data of clinical application of cephalosporin skin test and the occurrence of adverse drug reactions in Peking University Third Hospital from May 2020 to May 2022 were analyzed retrospectively.Clinical pharmacists first conducted baseline investigation to find out the main influencing factors and focused on management.Then,we analyzed the number of cephalosporin skin tests,skin test rate and consumption respectively.Meanwhile,we used the interrupt time series analysis(ITS)method.Clinical pharmacists analyzed the cephalosporin use density before intervention(from May 2020 to May 2021)and after intervention(from June 2021 to May 2022).RESULTS After de-adoption of cephalosporin skin test,the number of skin test cases,skin test rate and consumption decreased significantly,ranging from 85%to 89%,P<0.05.Before intervention,the cephalosporin use density decreased by 22.83%per month(P=0.002),and in the first month of intervention(June 2021),the cephalosporin use density increased by 82.52%(P=0.267).The change trend after intervention was 54.42%higher than-22.83%(P<0.001).At the same time,the antimicrobial use density decreased in 2021 compared with the same period in 2020.There was no significant difference in the incidence of adverse reactions.CONCLUSION Through standardized management,the number of skin tests,the rate of skin tests and the consumption of cephalosporin decreased significantly,and the cephalosporin use density increased significantly while the total antimicrobial use density decreased,which optimized the structure of clinical use of antibiotics to a certain extent,and the incidence of adverse reactions did not increase.The intervention study on de-adoption of routine skin test for cephalosporin prescribing led by clinical pharmacists has achieved good results.