ASP对胸外科围手术期抗菌药物选择和感染发病率的影响
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摘要
目的评价抗菌药物管理项目(ASP)对胸外科围手术期抗菌药物选择和患者术后感染发病率的影响。方法选取2015—2016年于某院胸外科进行肺或食管手术且术前无感染的患者。2015年的患者设为对照组(干预前),2016年的患者设为试验组(干预后)。2016年开展ASP,临床药师、感染科医生对使用碳青霉烯类药物和氟喹诺酮类药物的医嘱实时干预,规范抗菌药物的使用。比较实施ASP前后胸外科围手术期抗菌药物选择的规范程度和手术部位感染发生情况。结果干预前(2015年)纳入患者953例;干预后(2016年)纳入患者1 061例。食管或肺部手术患者手术部位感染发病率干预前、干预后分别为1. 57%、1. 70%,两者比较差异无统计学意义(χ~2=0. 047,P=0. 829)。使用推荐抗菌药物(头孢呋辛或头孢美唑)预防手术部位感染的比率从干预前的37. 15%(354/953)上升至干预后的69. 75%(740/1 061),干预前后比较差异有统计学意义(χ~2=215. 025,P=0. 000)。干预前、干预后胸外科抗菌药物AUD情况比较,厄他培南的AUD下降52. 46%(8. 12 VS 3. 86);头孢呋辛(7. 49 VS14. 83)和头孢美唑(4. 98 VS 9. 72)的AUD分别增加98. 00%、95. 18%;头孢曲松的使用强度下降85. 29%(12. 03VS 1. 77)。结论实施ASP,降低了胸外科厄他培南和头孢曲松的使用量,规范了胸外科手术预防用药,且不会引起肺和食管手术手术部位感染发病率的变化。
Objective To evaluate the effect of antimicrobial stewardship program (ASP) on peri-operative antimicrobial selection and incidence of postoperative infection in patients undergoing thoracic surgery. Methods From 2015 to2016,patients who underwent lung or esophageal surgery in the department of thoracic surgery of a hospital and without infection before operation were selected. Patients in 2015 were in control group (before intervention),and patients in 2016 were in trial group (after intervention). ASP was performed in 2016,clinical pharmacists and doctors in infectious department standardized antimicrobial use through conducting real-time intervention in doctors' orders for the use of carbapenems and fluoroquinolones. Standardized antimicrobial use and occurrence of surgical site infection (SSI) before and after the implementation of ASP were compared. Results Before and after intervention,953 and 1 061 patients were enrolled respectively. Incidence of SSI in patients undergoing esophageal and lung surgery before and after intervention were 1. 57% and1. 70% respectively,with no significant difference (χ~2= 0. 047,P = 0. 829). The rate of recommended use of antimicrobial agents (cefuroxime or cefmetazole) for preventing SSI rose from 37. 15% (354/953) before intervention to 69. 75% (740/1 061) after intervention,with a statistically significant difference before and after intervention (χ~2= 215. 025,P =0. 000). Comparison in AUD of antimicrobial agents in thoracic surgery before and after intervention showed that AUD of ertapenem decreased by 52. 46% (8. 12 VS 3. 86),cefuroxime and cefmetazole increased by 98. 00% (7. 49 VS 14. 83)and 95. 18% (4. 98 VS 9. 72) respectively; ceftriaxone decreased by 85. 29% (12. 03 VS 1. 77). Conclusion The implementation of ASP reduced the usage of ertapenem and ceftriaxone,standardized preventive medication in thoracic surgery,and didn't cause changes in the incidence of SSI in lung and esophageal surgery.
Objective To evaluate the effect of antimicrobial stewardship program (ASP) on peri-operative antimicrobial selection and incidence of postoperative infection in patients undergoing thoracic surgery. Methods From 2015 to2016,patients who underwent lung or esophageal surgery in the department of thoracic surgery of a hospital and without infection before operation were selected. Patients in 2015 were in control group (before intervention),and patients in 2016 were in trial group (after intervention). ASP was performed in 2016,clinical pharmacists and doctors in infectious department standardized antimicrobial use through conducting real-time intervention in doctors' orders for the use of carbapenems and fluoroquinolones. Standardized antimicrobial use and occurrence of surgical site infection (SSI) before and after the implementation of ASP were compared. Results Before and after intervention,953 and 1 061 patients were enrolled respectively. Incidence of SSI in patients undergoing esophageal and lung surgery before and after intervention were 1. 57% and1. 70% respectively,with no significant difference (χ~2= 0. 047,P = 0. 829). The rate of recommended use of antimicrobial agents (cefuroxime or cefmetazole) for preventing SSI rose from 37. 15% (354/953) before intervention to 69. 75% (740/1 061) after intervention,with a statistically significant difference before and after intervention (χ~2= 215. 025,P =0. 000). Comparison in AUD of antimicrobial agents in thoracic surgery before and after intervention showed that AUD of ertapenem decreased by 52. 46% (8. 12 VS 3. 86),cefuroxime and cefmetazole increased by 98. 00% (7. 49 VS 14. 83)and 95. 18% (4. 98 VS 9. 72) respectively; ceftriaxone decreased by 85. 29% (12. 03 VS 1. 77). Conclusion The implementation of ASP reduced the usage of ertapenem and ceftriaxone,standardized preventive medication in thoracic surgery,and didn't cause changes in the incidence of SSI in lung and esophageal surgery.
引文
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[13]蒋倩,蒋刚,马雪,等.食管癌患者围手术期抗菌药物选用与术后肺部感染的相关性研究[J].中华医院感染学杂志,2015,25(11):2459-2464.
[14]国家食品药品监督管理总局.关注氟喹诺酮类药品的严重不良反应[EB/OL].(2013-11-21)[2017-11-21].http://www.sda.gov.cn/WS01/CL0078/94324.html.
[15]FDA.FDA updates warnings for fluoroquinolone antibiotics[EB/OL].(2016-07-26)[2017-11-21].https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm513183.htm.
[16]Banerjee T,Anupurba S.Risk factors associated with fluoroquinolone-resistant enterococcal urinary tract infections in a tertiary care university hospital in north India[J].Indian J Med Res,2016,144(4):604-610.
[17]韩晓霞,韩萍,杨玉伦.食管癌根治术患者围手术期感染预防性措施[J].中华医院感染学杂志,2014,24(12):3006-3010.
[2]Hu FP,Guo Y,Zhu DM,et al.Resistance trends among clinical isolates in China reported from CHINET surveillance of bacterial resistance,2005-2014[J].Clin Microbiol Infect,2016,22(Suppl 1):S9-S14.
[3]Couderc C,Jolivet S,Thiébaut AC,et al.Fluoroquinolone use is a risk factor for methicillin-resistant Staphylococcus aureus acquisition in long-term care facilities:a nested case-case-control study[J].Clin Infect Dis,2014,59(2):206-215.
[4]Cohen AE,Lautenbach E,Morales KH,et al.Fluoroquinoloneresistant Escherichia coli in the long-term care setting[J].Am JMed,2006,119(11):958-963.
[5]马红映,汪丽,虞亦鸣,等.院内获得耐碳青霉烯类抗菌药物肺炎克雷伯菌感染的危险因素分析[J].中华医院感染学杂志,2017,27(7):1456-1458.
[6]Barlam TF,Cosgrove SE,Abbo LM,et al.Implementing an Antibiotic Stewardship Program:Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America[J].Clin Infect Dis,2016,62(10):e51-e77.
[7]李鹏,毛永彬,刘成涛.肺叶切除术患者手术部位感染的影响因素[J].中华医院感染学杂志,2013,23(21):5198-5202.
[8]中华人民共和国卫生部.医院感染诊断标准(试行)[S].北京,2001.
[9]《抗菌药物临床应用指导原则》修订工作组.抗菌药物临床应用指导原则(2015年版)[M].7版.北京:人民卫生出版社,2016:23.
[10]Dellit TH,Owens RC,Mc Gowan JE Jr,et al.Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship[J].Clin Infect Dis,2007,44(2):159-177.
[11]Bratzler DW,Dellinger EP,Olsen KM,et al.Clinical practice guidelines for antimicrobial prophylaxis in surgery[J].Am JHealth Syst Pharm,2013,70(3):195-283.
[12]Turna A,Kutlu CA,Ozalp T,et al.Antibiotic prophylaxis in elective thoracic surgery:cefuroxime versus cefepime[J].Thorac Cardiovasc Surg,2003,51(2):84-88.
[13]蒋倩,蒋刚,马雪,等.食管癌患者围手术期抗菌药物选用与术后肺部感染的相关性研究[J].中华医院感染学杂志,2015,25(11):2459-2464.
[14]国家食品药品监督管理总局.关注氟喹诺酮类药品的严重不良反应[EB/OL].(2013-11-21)[2017-11-21].http://www.sda.gov.cn/WS01/CL0078/94324.html.
[15]FDA.FDA updates warnings for fluoroquinolone antibiotics[EB/OL].(2016-07-26)[2017-11-21].https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm513183.htm.
[16]Banerjee T,Anupurba S.Risk factors associated with fluoroquinolone-resistant enterococcal urinary tract infections in a tertiary care university hospital in north India[J].Indian J Med Res,2016,144(4):604-610.
[17]韩晓霞,韩萍,杨玉伦.食管癌根治术患者围手术期感染预防性措施[J].中华医院感染学杂志,2014,24(12):3006-3010.