目的 了解抗菌药物专项整治活动前后我院抗菌药物使用和细菌耐药性变化趋势。方法 采用自身前后对照方法,对我院抗菌药物专项整治前(2010年)和整治后(2011~2013年)抗菌药物使用情况和细菌耐药性进行分析。结果 与2010年相比,2011~2013年抗菌药物专项整治活动期间我院的门诊量和收治患者人天数分别增加20.8%和21.4%,但全院抗菌药物采购金额、住院患者抗菌药物使用量、住院患者抗菌药物使用强度、住院患者抗菌药物使用率和门诊患者抗菌药物处方比例分别下降2.6%(262.23万元)、16.4%(46 985.91DDDs)、31.1%(17.88DDD/100人)、17.3%(64.1% vs 46.8%)和25.2%(2.1%);整治前后我院抗菌药物使用种类发生变化,2011~2013年一代头孢、二代头孢、三代头孢、硝基咪唑类、氨基糖苷类和糖肽类等6类抗菌药物采购量呈下降趋势,分别下降36.0%、20.2%、10.7%、8.1%、7.0%和2.0%;抗菌药物采购量增加幅度较大的包括酰胺醇类(198.0%)、浅表抗真菌类(103.7%)、磺胺类(60.8%)、四环素类(39.0%)、林可霉素类(38.4%)、碳青霉烯类(37.5%)和四代头孢(33.8%);与2010年相比,2013年全院甲氧西林耐药金黄色葡萄球菌(MRSA)、产ESBL大肠埃希菌和产ESBL肺炎克雷伯菌的检出率下降明显,分别降低13.8%(43.4% vs 29.6% )、6%(56.2% vs 50.2%)和5.6%(30.4% vs 24.8%),其他多药耐药菌的检出率和2010年相比变化不大。结论 3年全国抗菌药物专项整治活动在我院取得了显著成效,抗菌药物的使用和细菌的耐药性得到了较好的控制,应进一步持续监测抗菌药物使用和细菌耐药性。
Abstract
OBJECTIVE To investigate the prescribing pattern and the antimicrobial resistance of clinical isolates before and after implementation of a 3-year national antimicrobial stewardship program. METHODS This was a before- and-after controlled study, which was carried out in a 2000 beds tertiary comprehensive hospital. The intervention was a 3-year national antimicrobial stewardship program (ASP) from 2011-2013 year. Antibiotic consumption and antimicrobial resistance from 2010 to 2013 year were analyzed. RESULTS Compared with 2010 year, outpatient visits and inpatient days in 2011-2013 increased by 20.8% and 21.4%, but cost of antimicrobial purchasing ,antimicrobial consumption quantities by inpatients (DDD per 100 occupied bed-days) , percent of inpatients who received antimicrobial during hospitalization and the ratio of outpatients who received antimicrobial prescription decreased by 2.6%, 31.1 % ,17.3% and 5.2%. After the 3-year national ASP, antimicrobial purchasing quantities (2011-2013) of the 1st generation cephalosporin, 2nd generation cephalosporin, 3rd generation cephalosporin, nitroimidazole, aminoglycosides and glycopeptides in our hospital decreased by 36.0%, 20.2%, 10.7%, 8.1%, 7.0% and 2.0% compared with 2010. Antimicrobials whose purchasing quantities increased after ASP (2011-2013) were chloramphenicol(198.0%),superficial antifungal (103.7%), sulfonamides(60.8%),tetracyclines (39.0%), clindamycin (38.4%), carbapenems (37.5%) and 4th generation cephalosporin(33.8%). Compared with 2010, the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) , ESBLs-positive in the strains of E.coli and ESBLs-positive in the strains of Klebsiella pneumoniae decreased by 13.8%(43.4% vs 29.6% ),6%(56.2% vs 50.2%)and 5.6%(30.4% vs 24.8%).The other multi-drug resistant organisms incidence was similar with 2010 year. CONCLUSION The 3-year national antimicrobial stewardship program is associated with reductions in antimicrobial use and multi-drug resistant organism incidence in our hospital. Continuing surveillance should be done.
关键词
抗菌药物管理 /
抗菌药物 /
细菌耐药性
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Key words
antimicrobial stewardship program /
antimicrobial /
antimicrobial resistance
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中图分类号：
R952
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参考文献
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