优化碳青霉烯和糖肽类抗生素临床应用的策略研究  

A hospital-wide intervention program to optimize the utilization quality of carbapenems and glycopeptides

作　　者：曹彬[1,2] 孙立英[1] 刘坤[1] 李瑞生[1] 刘颖梅[2] 童朝辉[3] 李文雄[4] 潘世芬[5] 杨勇[6] 黄克武[3] 李春盛[7] 陈阳育[5] 王鹤尧[5] 李斌[8] 胡燕生[8] 侯生才[9] 王辰[3] 

机构地区：[1]首都医科大学附属北京朝阳医院医院感染管理科,100020 [2]首都医科大学附属北京朝阳医院医院感染和临床微生物科,100020 [3]首都医科大学附属北京朝阳医院医院呼吸与危重症医学科科,100020 [4]首都医科大学附属北京朝阳医院医院外科,100020 [5]首都医科大学附属北京朝阳医院医院药事部,100020 [6]首都医科大学附属北京朝阳医院医院泌尿外科,100020 [7]首都医科大学附属北京朝阳医院医院急诊科,100020 [8]首都医科大学附属北京朝阳医院医院病案科,100020 [9]首都医科大学附属北京朝阳医院医院胸外科,100020

出　　处：《中华医学杂志》2009年第36期2557-2560,共4页National Medical Journal of China

摘　　要：目的探索优化碳青霉烯和糖肽类抗生素临床应用的策略。方法建立以医院感染管理科为主体的碳青霉烯和糖肽类抗生素使用管理制度，对2007年11月1日至2008年10月31日在北京朝阳医院住院期间使用碳青霉烯类（碳青霉烯组）和糖肽类（糖肽组）抗生素的所有出院患者进行两类抗生素用药情况的回顾性审核，发现不合理用药情况提交院内核心专家组讨论，发放反馈信并与临床科室沟通。为较客观地评价制度管理的成效，分制度实施前半年和后半年2组进行分析，主要指标为有指征用药患者比例、患者住院时间、住院花费、住院病死率和医院耐万古霉素肠球菌（VRE）分离率。结果研究期间使用碳青霉烯和糖肽类抗生素的患者共397例，碳青霉烯组246例，糖肽组151例。组织核心专家组讨论9次，讨论75例，给临床科室主任发放反馈信58封。管理制度实施的后半年与前半年相比，碳青霉烯组和糖肽组有指征用药比例分别由37．8％（45／119）升高到53．5％（68／127）（P〈0．05）、45．6％（36／79）升高到63．9％（46／72）（P〈0．05）；糖肽组患者住院花费的M（Q1-Q3）由6．57（3．03—14．69）万元降低到5．57（3．67～9．09）万元，住院病死率由39．2％降低到26．4％，均呈下降趋势。医院VRE分离率由2007年的5．63％降低到2008年下半年的3．8％，呈下降趋势。结论加强制度管理可明显优化碳青霉烯和糖肽类抗生素的使用。Objective To investigate the impact of intervention program upon improvement of utilization quality of earbapenems and glycopeptides. Methods Multifaceted intervention program of earbapenems and glycopeptides was conducted at our hospital. It involved written justification forms, expert consultation committee meetings, audit, feedback and re-feedback. From November 1,2007 until October 31,2008, retrospective audit and feedback were performed on all patients dosed with carbapenenms or glycopeptides. Case reports were reviewed and data of ratio of appropriate antibiotic use, length of hospital stay, total cost, mortality and rate of vancomycin-resistant Enterococci （VRE） were collected and compared between the first and second half year of antibiotic intervention program. Results A total of 397 cases were reviewed, 75 cases discussed at expert committee meetings and 58 feedback letters delivered to responsible doctors. The consumption of both carbapenems and glycopeptides decreased. The appropriate use of carbapenems and glycopeptides increased from 37.8% （45/119） to 53.5% （48/127, P 〈 0. 05 ） and from 45.6% （36/79） to 63.9% （46/72, P 〈 0. 05） respectively. The total cost and mortality of patients dosed with glyopeptides decreased from a median of RMB 65 700 （30 300 - ]d6 900） yuan to 55 700 （36 700 - 90 900） yuan, and from 39. 2% to 26. 4% respectively. The rate of VRE decreased from 5.63% in 2007 to 3.80% during the second half year of 2008. Conclusion Antibiotic intervention program of carbapenems and glycopeptides is effective in decreasing the inappropriate antibiotic use.

关 键 词：卡巴配能类 糖肽类 药物利用评审 费用 医疗 

分 类 号：R686[医药卫生—骨科学]