北京市医疗机构β内酰胺类抗菌药物皮肤试验现状的分析

Analysis of the current situation of skin test forβ-lactam antibiotics in medical institutions in Beijing

目的了解北京市155家医院β内酰胺类抗菌药物皮肤试验的现状。方法通过问卷调研对β内酰胺类抗菌药物皮肤试验现状进行统计描述,并通过费希尔精确检验、卡方检验分析相关影响因素。结果本研究共收到155家医疗机构反馈的信息问卷3097份,有效的调研问卷3057份(有效率98.71%)。本次调研有122家医院在使用静脉青霉素类药物前进行皮肤试验,占123家有静脉青霉素类药物调研医院的99.19%。有抗感染药师的医院在静脉青霉素类药物使用前更多的做了皮肤试验(98.59%us88.46%,P<0.001),部分医院在口服青霉素类药物使用前不做皮肤试验。有70家医院(45.16%)尚未取消头孢菌素类药物皮肤试验,配备抗感染药师的医院更多地取消了常规皮肤试验(59.74%us50.00%,P<0.05),更多的三级医院取消了头孢菌素皮肤试验(80.65%us51.40%、29.41%,P<0.01)。在《β内酰胺类抗菌药物皮肤试验指导原则(2021年版)》颁布后,一级医院与二级医院相比,更多医院据此制订或更新了院内皮肤试验管理的制度或办法(72.22%us41.18%,P<0.05);有抗感染药师的医院更多地对本院的皮肤试验管理制度或办法进行了制定或者更新(78.57%vs60.00%,P<0.05),同时对皮试管理的制度或办法的全院宣传更有推动作用(92.65%us80.46%,P<0.05)。结论目前,北京市仍有部分医院未取消头孢菌素皮肤试验,三级医院取消头孢菌素皮肤试验的实践优于一、二级医院。

Objective To investigate the current situation of skin tests forβ-lactams in 155hospitalsinBeijing.Methods The questionnaires were sent to medical institutions in Beijing to statistically described the current situation ofβ-lactams skin test,and the relevant influencing factors were analyzed by Fisher exact test,and Chi-square test.ResultsA total of 3097 questionnaires were received from 155 medical institutions,of which 3057 were valid questionnaires(effective rate is 98.71%).In this study,122 hospitals conducted skin test before using intravenous penicillins,accounting for 99.19%of 123 hospitals with intravenous penicillins.Hospitals with infectious disease pharmacists conducted more skin tests before using intravenous penicillins(98.59%vs 88.46%,P<0.001),and some hospitals didn't conduct skin tests before using oral penicillins.Seventy hospitals(45.16%)had not yet cancelled skin tests for cephalosporins,more hospitals with infectious disease pharmacists cancelled routine skin test(59.74%us 50.00%,P<0.05),and more tertiary hospitals cancelled cephalosporin skin test(80.65%vs 51.40%,29.41%,all P<0.01).After the promulgation of the"Guiding Principle for Skin Test ofβ-lactams(2021 edition)",more primary hospitals have developed or updated the rules or regulation for skin test ofβ-lactams according to the Guiding Principle,compared with secondary hospitals(72.22%us 41.18%,P<0.05).Hospitals with infectious disease pharmacists developed or updated the rules or regulation for skin test ofβ-lactams in their hospitals(78.57%vs 60.00%,P<0.05).Infectious disease pharmacists had promoting effect on the publicity of the rules or regulation of skin test in the hospital(92.65%us 80.46%,P<0.05).Conclusion Many hospitals in Beijing have not cancelled cephalosporins skin test,and the current situation of cancelling cephalosporins skin test in tertiary hospitals is better than that in primary and secondary hospitals.