感染预防控制与抗菌药物管理协同降低细菌耐药水平的临床实践  

Clinical practice of collaboration of infection prevention and control and antimicrobial stewardship in reducing bacterial resistance

作　　者：邹妮[1] 朱丹[1] 王丹[1] 舒文[2] 王琳 李琴[3] ZOU Ni;ZHU Dan;WANG Dan;SHU Wen;WANG Lin;LI Qin(Department of Healthcare-associated Infection Prevention and Control,Shanghai General Hospital,Shanghai 201620,China;Department of Laboratory Medicine,Shanghai General Hospital,Shanghai 201620,China;Department of Clinical Pharmacy,Shanghai General Hospital,Shanghai 201620,China)

机构地区：[1]上海市第一人民医院院感防控办公室,上海201620 [2]上海市第一人民医院检验科,上海201620 [3]上海市第一人民医院临床药学科,上海201620

出　　处：《中国感染控制杂志》2024年第7期860-867,共8页Chinese Journal of Infection Control

基　　金：上海市申康医院发展中心技术规范化管理和推广项目(SHDC22022211);上海市松江区科技攻关(医疗卫生类)项目(21SJKJGG94)。

摘　　要：目的探讨医疗机构应用感染预防控制(IPC)与抗菌药物管理(AMS)的协同模式降低细菌耐药水平的效果。方法收集某院2015年1月1日—2022年12月31日所有住院患者医院感染管理、抗菌药物相关指标及多重耐药菌(MDRO)检出率,评估IPC联合AMS协同模式的效果。结果与2015—2016年比较,2021—2022年MDRO医院感染发病率从0.22%下降至0.16%(P<0.05),住院患者抗菌药物使用强度从48.48下降至42.17,抗菌药物使用率从49.45%下降至45.21%(P<0.05);Ⅰ类切口手术预防性抗菌药物使用率从48.62%下降至33.13%(P<0.05);与2017—2018年比较,2021—2022年抗菌药物治疗前病原学送检率从60.73%上升至72.18%(P<0.05)。与2015—2016年比较,2021—2022年除耐万古霉素粪肠球菌检出率略有上升,其余各类常见MDRO检出率均下降,尤其是耐甲氧西林金黄色葡萄球菌、耐碳青霉烯类鲍曼不动杆菌、耐碳青霉烯类铜绿假单胞菌、产广谱β-内酰胺酶肺炎克雷伯菌、产广谱β-内酰胺酶大肠埃希菌、耐氟喹诺酮类大肠埃希菌,差异均有统计学意义(均P<0.05)。结论采取IPC与AMS的协同模式,可有效促进抗菌药物合理使用,减少MDRO的产生和传播,降低细菌耐药。Objective To explore the effect of collaborative mode of adopting infection prevention and control(IPC)and antimicrobial stewardship(AMS)by medical institutions on reducing bacterial resistance.Methods Healthcare-associated infection(HAI)management and antimicrobial-related indicators,as well as multidrug-resis-tant organism(MDRO)detection rates of all hospitalized patients in a hospital from January 1,2015 to December 31,2022 were collected.The effectiveness of collaborative mode of IPC and AMS was evaluated.Results Compared with 2015-2016,the incidence of MDRO HAI in 2021-2022 decreased from 0.22%to 0.16%(P<0.05),antimicrobial use density in hospitalized patients decreased from 48.48 to 42.17,antimicrobial use rate decreased from 49.45%to 45.21%(P<0.05).The use rate of prophylactic antimicrobial agents in classⅠincision surgery decreased from 48.62%to 33.13%(P<0.05).Compared with 2017-2018,pathogen detection rate before antimicrobial therapy increased from 60.73%to 72.18%in 2021-2022(P<0.05).Compared with 2015-2016,except the detection rate of vancomycin-resistant Enterococcus faecalis slightly increased in 2021-2022,detection rates of other common MDRO decreased,especially methicillin-resistant Staphylococcus aureus,carbapenem-resistant Acine-tobacter baumannii,carbapenem-resistant Pseudomonas aeruginosa,broad-spectrumβ-lactamase-producing Klebsiella pneumoniae,broad-spectrumβ-lactamase-producing Escherichia coli and fluoroquinolone-resistant Escherichia coli,differences were all statistically significant(all P<0.05).Conclusion The collaborative mode of IPC and AMS can effectively promote the rational use of antimicrobial agents,decrease the occurrence and transmission of MDRO,and decrease bacterial resistance.

关 键 词：感染预防控制 抗菌药物管理 细菌耐药 

分 类 号：R181.32[医药卫生—流行病学] R197.32[医药卫生—公共卫生与预防医学]