某大型教学医院实施抗菌药物整治项目的效果分析
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摘要
目的探究某大型教学医院实施抗菌药物整治项目取得的效果,研究该项目对抗菌药物耐药性以及住院患者预后的影响。方法采用前后对照的方法,计算比较从2011年采取持续干预措施的前后(2009年1月—2010年12月、2012年1月—2016年12月)某大型教学医院(4 300张床位)住院患者的抗菌药物使用强度(antibiotics use density,AUD)及多重耐药菌的检出率,分析整治措施对抗菌药物耐药性及患者预后的影响。结果实施抗菌药物干预整治后住院患者AUD显著下降(P<0.001),金黄色葡萄球菌对苯唑西林的耐药率有所下降(P<0.001),而鲍曼不动杆菌(P<0.001)和肺炎克雷伯菌(P=0.011)对碳青霉烯耐药率增加;AUD与同期患者平均住院日无相关性(P=0.644),与患者病死率呈正相关性(r=0.932,P=0.001)。结论实施抗菌药物干预管理可明显减少抗菌药物的使用,不增加患者平均住院日和病死率,整治项目对该院细菌耐药性影响具有多样性,耐碳青霉烯的革兰阴性菌仍是住院患者健康的最大威胁,仍需联合多种感染防控措施持续干预。
Objective To investigate the effects of antimicrobial management program on inpatients outcomes and antimicrobial resistance among clinical isolates in a large-scaled university hospital. Methods The antibiotics use density(AUD) and antimicrobial resistance rate of multi-drug resistant bacteria before(from January 2009 to December2010) and after(from January 2012 to December 2016) the intervention of antimicrobial management program in a largescaled university hospital(4 300 beds) were calculated and compared, and the correlations of AUD with average length of hospital stay and mortality rate were analyzed. Results The AUD was significantly decreased after intervention(P<0.001). The resistance rate of Staphylococcus aureus to oxacillin decreased(P<0.001). Among Gram-negative bacteria,the resistance rates to carbapenems in Acinetobacter baumannii(P<0.001) and Klebsiella pneumoniae increased(P=0.011).AUD was not correlated with the average length of hospital stay(P=0.644), while positively correlated with the in-hospital mortality rate(r=0.932, P=0.001). Conclusions The implementation of antimicrobial management program can significantly reduce the antimicrobial use and do not worsen patient outcomes in the hospital. The impact of the program on resistance varies significantly depending on both the bacterium and the agent, and carbapenem-non-susceptible Gramnegative bacilli emerges as a major threat. It is still necessary to combine other infection control measures.
Objective To investigate the effects of antimicrobial management program on inpatients outcomes and antimicrobial resistance among clinical isolates in a large-scaled university hospital. Methods The antibiotics use density(AUD) and antimicrobial resistance rate of multi-drug resistant bacteria before(from January 2009 to December2010) and after(from January 2012 to December 2016) the intervention of antimicrobial management program in a largescaled university hospital(4 300 beds) were calculated and compared, and the correlations of AUD with average length of hospital stay and mortality rate were analyzed. Results The AUD was significantly decreased after intervention(P<0.001). The resistance rate of Staphylococcus aureus to oxacillin decreased(P<0.001). Among Gram-negative bacteria,the resistance rates to carbapenems in Acinetobacter baumannii(P<0.001) and Klebsiella pneumoniae increased(P=0.011).AUD was not correlated with the average length of hospital stay(P=0.644), while positively correlated with the in-hospital mortality rate(r=0.932, P=0.001). Conclusions The implementation of antimicrobial management program can significantly reduce the antimicrobial use and do not worsen patient outcomes in the hospital. The impact of the program on resistance varies significantly depending on both the bacterium and the agent, and carbapenem-non-susceptible Gramnegative bacilli emerges as a major threat. It is still necessary to combine other infection control measures.
引文
1Roehr B.Renewed efforts are needed to curb antibiotic resistance.BMJ,2012,345(15):e7778.
2Hvistendahl M.Public Health.China takes aim at rampant antibiotic resistance.Science,2012,336(683):795.
3陈新谦,金有豫,汤光.新编药物学.17版.北京:人民卫生出版社,2001:34-134.
4中华人民共和国国家卫生和计划生育委员会.医院感染管理质量控制指标(2015年版).(2015-03-31)[2019-01-01].http://www.nhfpc.gov.cn/ewebeditor/uploadfile/2015/04/20150415094217171.pdf.
5Goldmann DA,Weinstein RA,Wenzel RP,et al.Strategies to prevent and control the emergence and spread of antimicrobialresistant microorganisms in hospitals.A challenge to hospital leadership.JAMA,1996,275(3):234-240.
6Elaine.细菌耐药再敲警钟.中国处方药,2010(10):17.
7Rogues AM,Dumartin C,Lasheras A,et al.Determinants of glycopeptides consumption in hospitals.Microb Drug Resist,2007,13(3):199-203.
8Yoshida J,Akagi K,Ishimaru T,et al.Drug resistance of Pseudomonas aeruginosa in four community hospitals:influence of antimicrobial use density.Jpn J Antibiot,64(4):247-253.
9张国兵,毛小红,吴志强,等.肺炎克雷伯菌耐药与抗菌药物使用强度的相关性分析.中华医院感染学杂志,2017,27(11):2427-2429.
10曾晓媛,杨红忠,彭毅强,等.2008年至2011年抗菌药物使用量与鲍曼不动杆菌耐药性的相关性研究.中国医师杂志,2012,14(11):1518-1520.
11陈玮.某三级综合医院细菌耐药与抗菌药应用相关性研究.济南:山东大学,2016.
12李耘,吕媛,郑波,等.中国细菌耐药监测研究2015-2016革兰氏阴性菌监测报告.中国临床药理学杂志,2017,33(23):2521-2542.
13蔡惠惠,王萍,赵水娣.我院抗菌药使用与鲍曼不动杆菌耐药性变化的相关性分析.中国药师,2016,19(4):712-714.
14周晴,胡必杰,黄声雷,等.SICU鲍氏不动杆菌耐药率与抗菌药物使用剂量相关性分析.中华医院感染学杂志,2012,22(19):4326-4329.
15荚恒敏,张亮.肺炎克雷伯菌对亚胺培南耐药性与其使用量的相关性研究.中国感染控制杂志,2013,12(5):336-338.
16陈佰义,何礼贤,胡必杰,等.中国鲍曼不动杆菌感染诊治与防控专家共识.中国医药科学,2012,2(8):3-8.
17Poumaras S,Poulou A,Tsakris A.Inhibitor-based methods for the detection of KPC carbapenemase-producing Enterobacteriaceae in clinical practice by using boronic acid compounds.J Antimicrob Chemother,2010,65(7):1319-1321.
18郭玉琴.儿科重症监护病房合理使用抗菌药物干预效果分析.广州:南方医科大学,2016.
19吕轶娟.基于卫生经济学理论的医院平均住院日影响因素研究.现代医院,2018,18(5):658-661.
2Hvistendahl M.Public Health.China takes aim at rampant antibiotic resistance.Science,2012,336(683):795.
3陈新谦,金有豫,汤光.新编药物学.17版.北京:人民卫生出版社,2001:34-134.
4中华人民共和国国家卫生和计划生育委员会.医院感染管理质量控制指标(2015年版).(2015-03-31)[2019-01-01].http://www.nhfpc.gov.cn/ewebeditor/uploadfile/2015/04/20150415094217171.pdf.
5Goldmann DA,Weinstein RA,Wenzel RP,et al.Strategies to prevent and control the emergence and spread of antimicrobialresistant microorganisms in hospitals.A challenge to hospital leadership.JAMA,1996,275(3):234-240.
6Elaine.细菌耐药再敲警钟.中国处方药,2010(10):17.
7Rogues AM,Dumartin C,Lasheras A,et al.Determinants of glycopeptides consumption in hospitals.Microb Drug Resist,2007,13(3):199-203.
8Yoshida J,Akagi K,Ishimaru T,et al.Drug resistance of Pseudomonas aeruginosa in four community hospitals:influence of antimicrobial use density.Jpn J Antibiot,64(4):247-253.
9张国兵,毛小红,吴志强,等.肺炎克雷伯菌耐药与抗菌药物使用强度的相关性分析.中华医院感染学杂志,2017,27(11):2427-2429.
10曾晓媛,杨红忠,彭毅强,等.2008年至2011年抗菌药物使用量与鲍曼不动杆菌耐药性的相关性研究.中国医师杂志,2012,14(11):1518-1520.
11陈玮.某三级综合医院细菌耐药与抗菌药应用相关性研究.济南:山东大学,2016.
12李耘,吕媛,郑波,等.中国细菌耐药监测研究2015-2016革兰氏阴性菌监测报告.中国临床药理学杂志,2017,33(23):2521-2542.
13蔡惠惠,王萍,赵水娣.我院抗菌药使用与鲍曼不动杆菌耐药性变化的相关性分析.中国药师,2016,19(4):712-714.
14周晴,胡必杰,黄声雷,等.SICU鲍氏不动杆菌耐药率与抗菌药物使用剂量相关性分析.中华医院感染学杂志,2012,22(19):4326-4329.
15荚恒敏,张亮.肺炎克雷伯菌对亚胺培南耐药性与其使用量的相关性研究.中国感染控制杂志,2013,12(5):336-338.
16陈佰义,何礼贤,胡必杰,等.中国鲍曼不动杆菌感染诊治与防控专家共识.中国医药科学,2012,2(8):3-8.
17Poumaras S,Poulou A,Tsakris A.Inhibitor-based methods for the detection of KPC carbapenemase-producing Enterobacteriaceae in clinical practice by using boronic acid compounds.J Antimicrob Chemother,2010,65(7):1319-1321.
18郭玉琴.儿科重症监护病房合理使用抗菌药物干预效果分析.广州:南方医科大学,2016.
19吕轶娟.基于卫生经济学理论的医院平均住院日影响因素研究.现代医院,2018,18(5):658-661.