临床微生物标本送检信息化管控系统的构建与应用  

Construction and application of informatization management system for clinical microbial specimen submission

作　　者：蒋鹏 许杰[2] 冯玮 鲁慧哲 张昕瑶 严继承[3] 王选锭[1] Jiang Peng;Xu Jie;Feng Wei;Lu Huizhe;Zhang Xinyao;Yan Jicheng;Wang Xuanding(Department of Antimicrobial Stewardship,The Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Information Centre,The Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Infection Control,The Second Affiliated Hospital of 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抗菌药物管理办公室,杭州310009 [2]浙江大学医学院附属第二医院信息中心,杭州310009 [3]浙江大学医学院附属第二医院感染管理科,杭州310009

出　　处：《中华医院管理杂志》2024年第5期356-361,共6页Chinese Journal of Hospital Administration

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：为切实发挥病原学诊断在抗菌药物合理使用中的指导作用,各级医院亟须建立临床微生物标本送检的有效管控体系。针对我国医疗机构普遍存在的抗菌药物治疗前微生物标本送检率较低、微生物标本结构不合理以及大多采集晨痰、晨尿标本进行病原学检测等问题,浙江大学医学院附属第二医院运用人工智能技术构建了临床微生物标本送检信息化管控系统,运用内置智能规则引擎对医生开立抗菌药物时的微生物标本采样送检实行全过程管控,促使医生在抗菌药物治疗使用前执行有样必采的要求,并推荐优先采集无菌标本;此外,以能够24 h不间断接收微生物标本并实时处理为目标改造实验室及送检流程。该管控系统于2015年12月开始在全院应用,2016—2023年每年6月的首剂治疗性使用抗菌药物前微生物标本送检率均值为79.2%,较2014年6月的41.7%提高90.2个百分点(χ^(2)=467.781,P<0.01);微生物标本结构持续优化,无菌标本在所有送检标本中的占比由2014年的47.2%提升至2023年的49.9%(χ^(2)=139.119,P<0.01);晨痰和晨尿标本的占比分别从2014年的65.2%和60.6%降至2023年的11.1%和16.9%(χ^(2)值分别为19787.434和4346.664,P<0.01),为临床提供了更可靠的病原学诊断依据,可为医疗机构改进病原学标本送检管理提供参考。To effectively play the guiding role of pathogenic diagnosis in the rational use of antibiotics,hospitals at all levels urgently need to establish an effective control system for clinical microbial specimen submission.In response to the common problems in medical institutions in China,such as the low rate of microbiological specimen submission before antibiotic treatment,unreasonable structure of microbiological specimens,and the majority of morning sputum and urine specimens collected for pathogen testing,the Second Affiliated Hospital of Zhejiang University School of Medicine has constructed a management system for clinical microbiological specimen submission using artificial intelligence technology.It used a built-in intelligent rule engine to implement full process control over the sampling and submission of microbiological specimens by doctors when prescribing antibiotics,urge doctors to implement the requirement of collecting samples before using antibiotics for treatment,and recommend priority the collection of sterile specimens.In addition,the hospital transformed the laboratory and testing process with the goal of receiving microbial samples 24 hours without interruption and inoculating in real-time.The informatization management system began to be applied throughout the hospital in December 2015.The average rate of microbial sample submission before the first therapeutic use of antibiotics from June 2016 to 2023 was 79.2%,an increase of 90.2 percentage points from 41.7% in June 2014(χ^(2)=467.781,P<0.01).The structure of microbial specimens continued to be optimized,and the proportion of sterile specimens in all submitted specimens increased from 47.2% in 2014 to 49.9%in 2023(χ^(2)=139.119,P<0.01).The proportion of morning sputum and morning urine specimens decreased from 65.2% and 60.6% in 2014 to 11.1% and 16.9% in 2023,respectively(χ^(2) values were 19787.434 and 4346.664,respectively,P<0.01),providing a more reliable basis for pathogenic diagnosis in clinical practice and providing reference for

关 键 词：微生物标本 信息系统 采样 抗菌药物 抗菌药物管理 

分 类 号：TP399[自动化与计算机技术—计算机应用技术] R197.32[自动化与计算机技术—计算机科学与技术]