某三级教学医院呼吸重症病房抗菌药物管理核查表的临床应用及评价

王雪; 汪雨贺; 高山; 侯婷婷; 洪磊; 朱裕林; 张永

doi:10.16766/j.cnki.issn.1674-4152.002704

某三级教学医院呼吸重症病房抗菌药物管理核查表的临床应用及评价

doi: 10.16766/j.cnki.issn.1674-4152.002704

王雪¹,
汪雨贺¹,
高山¹,
侯婷婷¹,
洪磊¹,
朱裕林²,
张永^{1, 3, ,}

1.
蚌埠医学院第一附属医院呼吸与危重症医学科，安徽蚌埠 233004
2.
蚌埠医学院第一附属医院药剂科
3.
安徽省呼吸系病临床基础重点实验室，安徽蚌埠 233004

基金项目:

安徽省重点研究与开发计划项目 1804h08020287

详细信息

通讯作者:
张永, E-mail: zsuzy@126.com

中图分类号: R969.3
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- 文章访问数: 223
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- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2021-12-18
- 网络出版日期: 2022-11-30

Evaluation and implementation of an antimicrobial stewardship checklist in a respiratory ICU ward in a tertiary teaching hospital

1.
Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的分析抗菌药物管理核查表实施前后呼吸监护室(RICU)抗菌药物的使用情况，探讨其临床价值。方法使用具有RICU特点的抗菌药物管理核查表，并回顾性分析蚌埠医学院第一附属医院2013年1月—2019年12月RICU所有患者的抗菌药物使用情况，将2013年1月—2015年12月实施核查表前的住院患者设为对照组，2017年1月—2019年12月实施核查表后的住院患者设为干预组，计算分析2组患者抗菌药物使用强度(AUD)、病原学送检、住院时间、好转率等信息。结果抗菌药物管理核查表实施后，对照组(329例)与干预组(550例)AUD值分别为207.51 DDD/(100人·d)和146.21 DDD/(100人·d)，特殊级抗菌药物使用率分别为67.99%(223/328)和25.83%(124/480，χ²=141.313，P < 0.001)，联合用药比例分别为94.82%(311/328)和65.21%(313/480，χ²=97.132，P < 0.001)，抗菌药物使用前微生物送检率分别为92.68%(304/328)和97.50%(468/480，χ²=10.621，P=0.001)，住院时间由8(6, 13)d降至8(5, 12)d，差异有统计学意义(Z=-1.965，P=0.049)。结论实施抗菌药物管理核查表可以降低抗菌药物使用强度，减少联合用药及高级别抗菌药物使用，有助于规范抗菌药物应用，具有较高的临床应用价值。
- 抗菌药物管理核查表 /
- 呼吸监护室 /
- 抗菌药物 /
- 合理用药 /
- 评价
Abstract: Objective To analyse the consumption of antimicrobials in the respiratory intensive care unit (RICU) before and after the implementation of an antimicrobial stewardship checklist and evaluate the clinical application value of the antimicrobial stewardship checklist. Methods An antimicrobial stewardship checklist was designed according to RICU working practice. The antimicrobial-related data of all inpatients in the RICU of the First Affiliated Hospital of Bengbu Medical College from January 2013 to December 2019 were retrospectively analysed. Inpatients before the implementation of antimicrobial checklist management from January 2013 to December 2015 were set as the control group, and the remaining inpatients from January 2017 to December 2019, who were subject to antimicrobial checklist management, were set as the intervention group. The frequency of intensity of antibiotics use density (AUD), pathogenic test results, hospitalization improvement rate and length of RICU stay were calculated and analysed for both groups. Results After the implementation of the antimicrobial management checklist, the AUD values of the control group (n=329) and the intervention group (n=550) were 207.51 DDD/(100 people·day) and 146.21 DDD/(100 people·day), respectively. For the control group and the intervention group, the drug use rates were 67.99% (223/328) and 25.83% (124/480, χ²=141.313, P < 0.001), respectively; the combined drug ratios were 94.82% (311/328) and 65.21% (313/480, χ²=97.132, P < 0.001), respectively; and the rates of microbial testing before antimicrobial use were 92.68% (304/328) and 97.50% (468/480, χ²=10.621, P=0.001), respectively. The length of hospital stay decreased from 8 (6, 13) days to 8 (5, 12) days, and the difference was statistically significant (Z=-1.965, P=0.049). Conclusion The implementation of an antimicrobial stewardship checklist can help in reducing the intensity of antimicrobial drug use and reduce the frequency of combined use and high-grade use of antimicrobials, which is helpful to standardise the antimicrobial application and has high value in clinical application.
- Antimicrobial stewardship checklist /
- Respiratory intensive care unit /
- Antibacterial drugs /
- Rational drug use /
- Evaluation

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表 1 2013—2019年住院患者抗菌药物使用强度分析(AUD)

Table 1. Analysis of antibacterial drug use intensity in inpatients from 2013 to 2019(AUD)

抗菌药物分类	抗菌药物使用强度[DDD/(100人·d)]
抗菌药物分类	2013年	2014年	2015年	2016年	2017年	2018年	2019年
青霉素类	0.67	0.15	7.18	1.03	3.66	14.70	8.33
头孢菌素类	67.90	61.30	64.51	59.50	39.40	42.52	38.21
其他β-内酰胺酶类	0	0	0	0	0.59	0	0
氨基糖苷类	0.88	0.57	1.54	2.03	4.03	2.17	2.85
碳青霉烯类	39.82	36.26	31.42	10.87	11.74	9.61	11.66
四环素类	0	0	0	0	1.90	2.29	3.91
大环内酯类	14.18	8.00	15.89	9.21	8.49	17.10	7.38
糖肽类	14.22	11.58	5.10	2.23	2.33	2.97	3.00
喹诺酮类	48.13	62.77	87.88	78.87	56.89	48.72	50.95
硝基咪唑类	2.62	0.52	0	0	0.94	0	0
抗真菌药	14.51	12.60	9.11	11.18	8.87	8.59	8.93
其他类	1.28	2.51	2.25	2.69	0.82	6.23	7.36
合计	204.21	196.26	224.38	178.06	139.66	154.58	142.58

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表 2 2组住院患者常用抗菌药物使用强度比较[AUD，DDD/(100人·d)]

Table 2. Comparison of the use intensity of commonly used antibiotics between two groups of inpatients[AUD, DDD/(100 persons·d)]

组别	例数	青霉素类	头孢菌素类	碳青霉烯类	大环内酯类	糖肽类	喹诺酮类	抗真菌药	所有抗菌药
对照组	329	2.58	64.93	35.99	12.73	10.46	64.80	12.17	207.51
干预组	550	9.41	40.15	10.91	12.73	2.80	51.77	8.79	146.21

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表 3 2组住院患者特殊级抗菌药物使用强度比较[AUD，DDD/(100人·d)]

Table 3. Comparison of the use intensity of special antibiotics between two groups of inpatients[AUD, DDD/(100 persons·d)]

组别	例数	亚胺培南西司他丁钠	美罗培南	替加环素	去甲万古霉素	万古霉素	利奈唑胺	伏立康唑	卡泊芬净	头孢吡肟	合计
对照组	329	14.09	87.60	0	6.42	4.04	0.26	2.90	0	2.02	51.64
干预组	550	7.10	3.81	2.75	0.43	2.73	2.23	3.24	1.20	0	23.13
注：2013—2015年同期收治患者人天数为4 545 d，2017—2019年同期收治患者人天数为5 474 d。

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表 4 2组住院患者抗菌药物联合使用情况比较[例(%)]

Table 4. Comparison of combined use of antimicrobial agents between two groups of inpatients [cases(%)]

组别	例数	使用例数	单一用药	二联用药	三联用药	四联用药
对照组	329	328(99.70)	17(5.18)	250(76.22)	55(16.77)	6(1.83)
干预组	550	480(87.27)	167(34.79)	265(55.21)	42(8.75)	6(1.25)
χ²值		42.791	97.132	37.218	11.859	0.447
P值		< 0.001	< 0.001	< 0.001	0.001	0.504

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表 5 2组住院患者微生物送检情况比较

Table 5. Comparison of microbial submission for examination between two groups of inpatients

组别	例数	特殊级药物使用(例)	特殊级病原学送检[例(%)]	总抗菌药物使用(例)	总病原学送检[例(%)]
对照组	329	223	210(94.17)	328	304(92.68)
干预组	550	124	124(100.00)	480	468(97.50)
χ²值		141.313	7.510	42.791	10.621
P值		< 0.001	0.006	< 0.001	0.001

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表 6 2组住院患者一般临床情况分析

Table 6. Analysis of general clinical situation between two groups of inpatients

组别	例数	住院时间[ M(P₂₅, P₇₅)，d]	用药时间[ M(P₂₅, P₇₅)，d]	抗菌药物费用[ M(P₂₅, P₇₅)，元]	西药费用[ M(P₂₅, P₇₅)，元]	总费用[ M(P₂₅, P₇₅)，元]	好转[例(%)]
对照组	329	8(6, 13)	8(6, 13)	5 353.82(2 133.46, 7 983.35)	8 314.79(4 610.46, 15 689.13)	33 164.13(18 848.30, 59 015.81)	219(66.56)
干预组	550	8(5, 12)	7(4, 10)	1 581.56(527.92, 3 551.97)	4 311.37(2 366.84, 8 640.11)	24 107.93(15 428.18，48 219.70)	395(71.82)
统计量		-1.965^a	-6.040^a	-11.370^a	-9.162^a	-4.395^a	2.697^b
P值		0.049	< 0.001	< 0.001	< 0.001	< 0.001	0.101
注：^a为Z值，^b为χ²值。

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