医院药师在建立抗菌药物管理长效机制中角色的探讨
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摘要
目的:探讨医院抗菌药物管理的工作策略。方法:分析现阶段国内医疗机构抗菌药物管理存在的问题,比较与美国抗菌药物管理工作的差异。从开展抗菌药物管理工作的人员、工作模式和工作内在动力三个方面探讨建立抗菌药物管理的长效机制。结果:美国抗菌药物管理计划的工作模式有很好的借鉴意义。结论:发挥医院药学力量的主导作用,优化抗菌药物管理工作模式并使医疗机构和医务人员有促进抗菌药物合理应用的内在需求与动力,是构建抗菌药物管理的长效机制的关键。
OBJECTIVE To investigate practical strategies of antimicrobial management. METHODS Practical strategies of antimicrobial management were compared between the United States and China, and existing barriers of antimicrobial management in China were analyzed. Staffing, strategies and internal motivation of implementation were discussed to build the long-term mechanism of antimicrobial management. RESULTS Strategies of antimicrobial stewardship program in the United States could be used as reference for antimicrobial management in China. CONCLUSIONIt is the key to build long term mechanism for antimicrobial management to play the prominent roles of pharmacists,optimize management mode of antibiotics, and provide the internal motivation for medical institution and medical staff to promote the rational application of antibiotics.
OBJECTIVE To investigate practical strategies of antimicrobial management. METHODS Practical strategies of antimicrobial management were compared between the United States and China, and existing barriers of antimicrobial management in China were analyzed. Staffing, strategies and internal motivation of implementation were discussed to build the long-term mechanism of antimicrobial management. RESULTS Strategies of antimicrobial stewardship program in the United States could be used as reference for antimicrobial management in China. CONCLUSIONIt is the key to build long term mechanism for antimicrobial management to play the prominent roles of pharmacists,optimize management mode of antibiotics, and provide the internal motivation for medical institution and medical staff to promote the rational application of antibiotics.
引文
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[17] Yang ZH, Zhang XG, Ma KF, et al. Analysis and thoughts on the development of clinical pharmacy in Chinese hospitals[J]. Chin Pharm(中国药学杂志),2015,(50):1553-1557.
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[27] Heinrich LS, Tokumaru S, Clark NM, et al. Development and implementation of a piperacillin-tazobactam extended infusion guideline[J]. J Pharm Pract, 2011,(24):571-576.
[28] Kollef MH, Morrow LE, Niederman MS, et al. Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia[J]. Chest, 2006,(129):1210-1218.
[29] Athanassa Z, Makris G, Dimopoulos G, et al. Early switch to oral treatment in patients with moderate to severe community-acquired pneumonia:a meta-analysis[J]. Drugs,2008,(68):2469-2481.
[2] Hicks LA, Taylor TH Jr, Hunkler RJ. U.S. outpatient antibiotic prescribing, 2010[J]. N Engl J Med. 2013,(368):1461-1462.
[3] Jin CM, Xiao AL, Yan L, et al. Investigation and analysis on antibacterial drug use in four cities of China[J]. Chin J Pharmacovigilance(中国药物警戒),2011,(8):216-219.
[4] Hahn AW, Jain R, Spach DH. New approaches to antibiotic use and review of recently approved antimicrobial agents[J].Med Clin North Am, 2016,(100):911-926.
[5] Cheng S, Luo X, Wen AP. Retrospective analysis of consultations of 69 infection cases in NICU involving clinical pharmacists[J]. Chin Hosp Pharm J(中国医院药学杂志),2018,(38):558-561.
[6] You HS, Hu SS, Dong YL, et al. Analysis of intervention effects of antibiotics in tumor patients by pharmacists[J].Chin Hosp Pharm J(中国医院药学杂志),2015,(35):1491-1495.
[7] Zheng ZJ, Wang WY, et al. Pharmacist intervention in spontaneous intracerebral hemorrhage[J]. Chin Hosp Pharm J(中国医院药学杂志),2018,(38):529-532.
[8] Zhang YH, Liu JW, Yuan Q, et al. Impact of national antimicrobial stewardship action plan on antimicrobial administration for inpatients[J]. Chin Hosp Pharm J(中国医院药学杂志),2016,(36):2012-2015.
[9] Pope SD, Dellit TH, Ovens RC, et al. Results of survey on implementation of Infectious Diseases Society of America and Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship[J]. Infect Control Hosp Epidemiol, 2009,(30):97-98.
[10] SHEA, IDSA, PIDS. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America(SHEA), the Infectious Diseases Society of America(IDSA), and the Pediatric Infectious Diseases Society(PIDS)[J]. Infect Control Hosp Epidemiol. 2012,(33):322-327.
[11] Traynor K. CDC says pharmacist-leaders crucial for antimicrobial stewardship[J]. Am J Health Syst Pharm.2014,(71):689-690.
[12] Dellit TH, Owens RC, McGowan 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):159-177.
[13] Li L, Tang LZ, Yang SY, et al. Interventional study on use time of prophylactic antibiotics for cesarean[J]. Chin Hosp Pharm J(中国医院药学杂志),2007,(36):855-859.
[14] Wang YP, J K, Wu XA. Experience of clinical pharmacist participationg in pharmaceutical care in pediatrics department[J]. China Pharmacy(中国药房),2011,(22):574-576
[15] Xiao YB, Ge WH, Y F. Antimicrobial stewardship programs[J]. Chin Hosp Pharm J(中国医院药学杂志),2013,(33):403-406.
[16] He CY, Wu Q, Fan JS. Practice and analysis of clinical pharmacists participating in pharmaceutical consultation for children with urinary tract infection[J]. China Pharm(中国药房),2018,(29):852-855.
[17] Yang ZH, Zhang XG, Ma KF, et al. Analysis and thoughts on the development of clinical pharmacy in Chinese hospitals[J]. Chin Pharm(中国药学杂志),2015,(50):1553-1557.
[18] Management methods for clinical application of antibiotics抗菌药物临床应用管理办法[Z]. ADR J(药物不良反应杂志)2012, 14:193-198.
[19] Li RL, Xiao YB. Effects of variety and specification restriction management of antibacterial agents on clinicalconsumption[J]. China Pharmacist(中国药师),2016,(19):1549-1552.
[20] Pang JL, Meng GY. Discussion on the second draft of control measure for clinical application of antimicrobial drugs(Consultative Paper)[J]. China Pharm(中国药房),2012,(23):2002-2005.
[21] Wu LY, Cai ZQ,Luo J, et al. Implementation of antimicrobial stewardship program in the United States and its enlightenment[J]. China Pharmaceuticals(中国药业),2015,(24):9-11.
[22] Calfee DP, Brooks J, Zirk NM, et al. A pseudo-outbreak of mosocomial infections associated with the introduction of an antibiotic management program[J].J Hosp Infect, 2003,(55):26-32.
[23] Burke JP. Antibiotic resistance-squeezing the balloon?[J].JAMA, 1998,(2810):1270-1271.
[24] Martin CA, Armitstead JA, Mynah RP, et al. Moving antimicrobial stewardship from restriction to facilitation[J].Am J Health Syst Pharm, 2011,(68):109-110.
[25] ASHP guidelines on the pharmacist's role in the development, implementation, and assessment of critical pathways[J]. Am J Health Syst Pharm, 2004,(61):939-945.
[26] Jr Lodise TP, Lomaestro B, Drusano GL. Piperacillintazobactam for pseudomonas aeruginosa infection:clinical implications of an extended-infusion dosing strategy[J].Clin Infect Dis, 2007,(44):357-363.
[27] Heinrich LS, Tokumaru S, Clark NM, et al. Development and implementation of a piperacillin-tazobactam extended infusion guideline[J]. J Pharm Pract, 2011,(24):571-576.
[28] Kollef MH, Morrow LE, Niederman MS, et al. Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia[J]. Chest, 2006,(129):1210-1218.
[29] Athanassa Z, Makris G, Dimopoulos G, et al. Early switch to oral treatment in patients with moderate to severe community-acquired pneumonia:a meta-analysis[J]. Drugs,2008,(68):2469-2481.