中南大学湘雅医院抗菌药物科学化管理的实践与评价  

Practice and evaluation of antimicrobial stewardship in Xiangya Hospital of Central South University

作　　者：袁磊[1,4] 黄耿文 黄勋[2] 尹桃[3] 王庆红[1,4] YUAN Lei;HUANG Geng-wen;HUANG Xun;YIN Tao;WANG Qing-hong(Department of Medical Administration,Xiangya Hospital,Central South University,Changsha 410008,China;Center for Healthcare-associated Infection Control,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Pharmacy,Xiangya Hospital,Central South University,Changsha 410008,China;Institute of Hospital Ma-nagement,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院医务部,湖南长沙410008 [2]中南大学湘雅医院医院感染控制中心,湖南长沙410008 [3]中南大学湘雅医院药学部,湖南长沙410008 [4]中南大学医院管理研究所,湖南长沙410008

出　　处：《中国感染控制杂志》2021年第12期1133-1138,共6页Chinese Journal of Infection Control

基　　金：中南大学湘雅医院管理研究基金(2019GL17)。

摘　　要：目的探讨如何构建抗菌药物科学化管理工作机制,为医疗机构加强抗菌药物管理与遏制细菌耐药趋势提供参考借鉴。方法借鉴抗菌药物科学化管理(AMS)策略,在中南大学湘雅医院建立AMS团队,规范抗菌药物的临床使用。选取3个维度9项指标,构建抗菌药物临床应用评价考核体系,并采用TOPSIS法对实施AMS前(2016年)与实施后(2017—2020年)抗菌药物临床应用9项指标的变化情况进行综合评价与分析。结果2016—2020年该院抗菌药物应用评价指标明显改善,住院患者抗菌药物使用强度由2016年的53.39下降至2020年的36.55,降幅达31.54%;住院患者抗菌药物使用率降幅为10.76%,住院患者抗菌药物次均费用降幅为41.45%,门诊患者抗菌药物使用率降幅为31.59%,急诊患者抗菌药物使用率降幅为43.53%,特殊使用级抗菌药物使用率降幅为47.89%,特殊使用级抗菌药物使用强度降幅为38.52%,多重耐药菌检出率降幅为9.89%,医院感染现患率降幅为37.50%。TOPSIS法评价结果显示,2020年抗菌药物应用情况为5年中最佳。结论AMS有助于促进医疗机构抗菌药物的合理应用,从而遏制细菌耐药性的发展。Objective To explore how to build a scientific management mechanism of antimicrobial stewardship(AMS),provide reference for strengthening the management of antimicrobial agents and curbing the trend of bacterial resistance in medical institutions.Methods Based on the strategy AMS,the AMS team was established in Xiangya Hospital of Central South University to standardize the clinical use of antimicrobial agents.Nine indexes in three dimensions were selected to build assessment system for clinical application of antimicrobial agents,and changes in nine indexes of clinical application of antimicrobial agents before(2016)and after(2017-2020)the implementation of AMS were comprehensively assessed and analyzed by technique for order preference by similarity to ideal solution(TOPSIS).Results From 2016 to 2020,the evaluation index of antimicrobial application in the hospital was significantly improved,antimicrobial use density(AUD)in hospitalized patients decreased from 53.39 in 2016 to 36.55 in 2020,with a decrease of 31.54%;antimicrobial use rate in hospitalized patients decreased by 10.76%,the average cost of antimicrobial agents in hospitalized patients decreased by 41.45%,antimicrobial use rate in outpatient and emergency patients decreased by 31.59%and 43.53%respectively,utilization rate of special use antimicrobial agents decreased by 47.89%,AUD of special use antimicrobial agents decreased by 38.52%,detection rate of multidrug-resistant organism decreased by 9.89%,prevalence rate of HAI decreased by 37.50%.TOPSIS evaluation results showed that the application of antimicrobial agents in 2020 was the best during five years.Conclusion AMS is helpful to promote the rational application of antimicrobial agents in medical institutions,and curb the development of resistance of bacteria.

关 键 词：抗菌药物 医疗机构 抗菌药物科学化管理 TOPSIS法 

分 类 号：R197.323.4[医药卫生—卫生事业管理]