数智技术赋能医院抗菌药物科学化管理的实践及评价

Practice and evaluation of hospital antimicrobial stewardship empowered by digital intelligence technology

目的 借助数智技术赋能医院抗菌药物科学化管理(AMS)体系,提高医院抗菌药物管理效率,保障临床抗菌药物合理使用。方法 将抗菌药物指标预警、微生物送检信息化闭环管理、耐药监测数据决策系统等信息化体系应用到传统AMS体系中,利用医院信息系统(HIS)收集开展数智技术改进前后深圳市某三级甲等公立医院住院患者治疗性使用抗菌药物及医院感染质控指标,其中2021年的指标为对照组(改进前),2022年的指标为观察组(改进后),对比抗菌药物管理指标改进趋势。结果 对医院信息系统升级改造后,各项医院抗菌药物管理指标较改造前有明显改善。观察组住院患者抗菌药物使用率、Ⅰ类切口手术抗菌药物预防使用率均低于对照组(分别为27.0%VS 38.8%、20.9%VS 23.8%),差异均有统计学意义(均P<0.05)。观察组住院患者抗菌药物使用强度(DDDs)低于对照组[(33.27±3.03)DDDs VS (42.06±4.42)DDDs],差异有统计学意义(t=13.11,P<0.001)。观察组抗菌药物医嘱点评合格率高于对照组(98.5%VS 96.8%),住院患者治疗性抗菌药物治疗前病原学送检率、医院感染诊断相关病原学送检率均较对照组上升(分别为87.1%VS 84.5%、99.0%VS 95.4%);差异均有统计学意义(均P<0.05)。结论 数智技术赋能医院AMS体系,可促使医院抗菌药物管理更加科学、规范、高效和合理。

Objective To improve the efficiency of hospital antimicrobial management and ensure rational clinical use of antimicrobial agents with the aid of antimicrobial stewardship(AMS)empowered by digital intelligence technology in hospital.Methods Information systems such as early warning of antimicrobial indexes,closed-loop ma-nagement of microbial detection information,and decision-making system of antimicrobial resistance monitoring data were applied to the traditional AMS system.Through hospital information systems(HIS)to collect data about thera-peutic antimicrobial use and healthcare-associated infection(HAI)quality control indexes of hospitalized patients in a tertiary first-class public hospital in Shenzhen City before and after digital technology improvement,indexes of 2021 and 2022 were as control group(before improvement)and observation group(after improvement)respectively,improvement trend of antimicrobial management was compared.Results After upgrading and renovating the hospital information system,hospital antimicrobial management indexes improved significantly compared to before the renovation.The use rate of antimicrobial agents and the preventive use rate of antimicrobial agents in classⅠincision surgery in patients in the observation group were both lower than those in the control group(27.0%vs 38.8%,20.9%vs 23.8%,respectively,both P<0.05).Antimicrobial use density in hospitalized patients in the observation group was lower than that in the control group([33.27±3.03]DDDs vs[42.06±4.42]DDDs),difference was statistically significant(t=13.11,P<0.001).The observation group had a higher qualified rate for evaluating antimicrobial medical orders compared to the control group(98.5%vs 96.8%).The pathogenic detection rate of hospitalized patients before therapeutic antimicrobial use and pathogen detection rate related to HAI diagnosis were both higher than those in the control group(87.1%vs 84.5%,99.0%vs 95.4%,respectively),differences were both statistically significant(both P<0.05).Conclusion Empowering the hospital’s AMS system with digital technology can promote more scientific,standardized,efficient,and rational antimicrobial management in hospitals.