特殊使用级抗菌药物信息化管理与成效分析  

Effectiveness of the special-grade antimicrobial stewardship based on information technology

作　　者：许杰[1] 蒋鹏 李雷清[3] 张昕瑶 胡阳敏[4] 戴海斌[4] 王选锭[2] Xu Jie;Jiang Peng;Li Leiqing;Zhang Xinyao;Hu Yangmin;Dai Haibin;Wang Xuanding(Information Centre,the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Antimicrobial Stewardship,the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China;Intensive Care Unit,the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Pharmacy,the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院IT中心,杭州310009 [2]浙江大学医学院附属第二医院抗菌药物管理办公室,杭州310009 [3]浙江大学医学院附属第二医院重症医学科,杭州310009 [4]浙江大学医学院附属第二医院药学部,杭州310009

出　　处：《中华临床感染病杂志》2022年第3期185-192,共8页Chinese Journal of Clinical Infectious Diseases

基　　金：国家卫生计生委科研基金省部共建项目(WKJ2014-2-011);浙江省级公益性技术应用研究计划项目(2015C33107)。

摘　　要：目的评估特殊使用级抗菌药物信息化管理系统对特殊使用级抗菌药物临床应用的管理成效,为合理用药和科学管理提供参考。方法在构建知识库基础上,设计嵌入式管理程序植入电子病历,自2015年起对特殊使用级抗菌药物医嘱实施过程干预。从浙江大学医学院附属第二医院HIS系统中提取特殊使用级抗菌药物信息化管理系统应用前后2013年1月至2020年12月所有出院患者的基本信息、抗菌药物使用医嘱明细和药库发药数据,对全院和重症监护病房(ICU)特殊使用级抗菌药物的使用率和使用强度变化进行趋势分析。采用SPSS 24.0对数据进行处理分析。结果2013至2015年,除美罗培南、两性霉素B外,全院各特殊使用级抗菌药物使用率均呈上升趋势(P值均<0.05)。全院特殊使用级抗菌药物使用量占比逐年升高(χ^(2)=7804.081,P<0.01)。ICU特殊使用级抗菌药物总使用率呈逐年上升趋势(χ^(2)=67.028,P<0.01)。2015年开始实施特殊使用级抗菌药物信息化管理以来,全院特殊使用级抗菌药物总使用率、除利奈唑胺、两性霉素B和泊沙康唑外的各种抗菌药物使用率及全院特殊使用级抗菌药物使用量占比均呈逐年下降趋势(P<0.01)。ICU特殊使用级抗菌药物总使用率和总使用强度均呈逐年下降趋势(χ^(2)=343.514,P<0.01;β=-0.963,P=0.002)。结论特殊使用级抗菌药物信息化管理系统能够切实降低包括ICU在内的住院患者大多数特殊使用级抗菌药物的使用率和使用强度,具有很好的临床推广应用价值。Objective To evaluate the effectiveness of the information management system on the clinical application of special-grade antimicrobial.Methods Using the established knowledge database,a computer program was designed and developed,which was embedded in the electronic medical record to intervene the clinical use of the special-grade antimicrobial since 2015.The basic information of all discharged patients from the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2013 to December 2020 were extracted from the HIS system,including the medical orders for antibiotics and the drug storehouse dispensing data.The trend analysis was carried out on the changes of the use rates and antibiotic use density(AUD)of the special-grade antimicrobials in the whole hospital and intensive care units(ICU).The data were processed and analyzed using SPSS 24.0.Results From 2013 to 2015,except for meropenem and amphotericin B,the usage rate of all special-grade antimicrobials in the whole hospital showed an upward trend(P<0.05).The proportion of special-grade antimicrobials used in the hospital increased year by year(χ^(2)=7804.081,P<0.01).The total usage rate of special-grade antimicrobials in ICU showed an upward trend year by year(χ^(2)=67.028,P<0.01).Since the implementation of the special-grade antimicrobial information management system in 2015,the total use rate of special-grade antimicrobials in the hospital,the use rate of various antibiotics except linezolid,amphotericin B and posaconazole,and the proportion of special-grade antimicrobials used in the hospital have all shown a downward trend year by year(P<0.01).The total usage rate and total AUD of special-grade antimicrobials in ICU showed a decreasing trend year by year(χ^(2)=343.514,P<0.01,β=-0.963,P=0.002).Conclusion The information management system for special-grade antimicrobial can effectively reduce the utilization rate and AUD of most special-grade antibiotics in hospitalized patients including ICU,and has a good clinical applicatio

关 键 词：抗菌药物 特殊使用级抗菌药物 抗菌药物管理 信息技术 

分 类 号：R954[医药卫生—药学]