目的 探讨实施综合干预措施在提高医院抗菌药物治疗前病原学送检率及防控细菌耐药方面的作用。方法 根据是否实施综合干预措施将研究对象分为干预组和对照组,对比分析对照组和干预组的患者住院期间抗菌药物治疗前的标本送检、病原菌检出、多重耐药菌检出以及医源性感染多重耐药菌情况。结果 治疗性使用抗菌药物的病原学标本送检率干预组是85.27%,对照组是58.79%,两组送检率差异具有统计学意义(χ2=416.678,P＜0.001);两组的病原学标本类型构成比差异具有统计学意义(χ2=12.610,P=0.006);两组的医源性感染的菌株数占比差异具有统计学意义(χ2=1.786,P=0.018);多重耐药菌的检出率干预组是52.63%,对照组是33.91%,两组差异具有统计学意义(χ2=12.967,P＜0.001)。结论 采取综合干预措施可以有效提高使用抗菌药物前病原微生物送检率,降低多重耐药菌的医院内传播,有效遏制和延缓病原菌耐药性的产生。
Abstract
Objective To explore the effect of comprehensive intervention measures in improving the rate of pathogenic inspection before antibiotic treatment in hospitals and preventing and controlling bacterial resistance. Methods The research subjects were divided into the experimental group and the control group according to whether comprehensive intervention measures were implemented.The control group and the experimental group were compared and analyzed in terms of specimen submission,pathogen detection,multidrug-resistant bacteria detection,and multidrug-resistant bacteria in hospital-acquired infection before antibiotic treatment during hospitalization. Results In the intervention group,the detection rate of pathogenic specimen for therapeutic use of antimicrobials was 85.27% ,and the control group was 58.79%,with a statistically significant(χ2=416.678,P＜0.001);there was a statistically significant difference in the composition ratio of etiological specimen types between the two groups (χ2=12.610,P=0.006);there was a statistically significant difference in the number of strains of iatrogenic infection between the two groups (χ2=1.786,P=0.018);the detection rate of multi-drug resistant bacteria was 52.63% in the intervention group and 33.91% in the control group,and the difference between the two groups was statistically significant (χ2=12.967,P＜0.001). Conclusion Taking comprehensive intervention measures can effectively improve the detection rate of pathogenic microorganisms before the therapeutic use of antibiotics,reduce the nosocomial spread of multidrug-resistant bacteria,effectively contain and delay the emergence of drug resistance of pathogenic bacteria.
关键词
合理使用抗生素 /
细菌耐药 /
干预措施 /
院感控制
Key words
Rational use of antibiotics /
Bacterial resistance /
Intervention measures /
Hospital infection control
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参考文献
[1] 许雪冉,孙强,阴佳,等.抗生素耐药性全球治理的发展历程及对中国的启示[J].中国卫生政策研究,2019,12(5):38-43.
[2] 黄勋,邓子德,倪雨星,等.多重耐药菌医院感染预防与控制中国专家共识[J].中国感染控制杂志,2015,14(1):1-9.
[3] 俞娟芬,邢虎,张德厚,等.多部门联合干预对重症监护病房多重耐药菌感染管理的效果研究[J].中国消毒学杂志,2022,39(1):58-61.
[4] 崔李平,李继泉.近2年革兰阴性菌耐药性及与抗菌药物使用相关性分析[J].西北药学杂志,2019,34(2):267-271.
[5] 孙盼盼,张宁,姜衍,等.抗菌药物用药频度与多重耐药鲍曼不动杆菌检出率的相关性分析[J].中国医院用药评价与分析,2018,18(7):987-989.
[6] 国家卫生计生委办公室,国家中医药管理局办公室,总后卫生部药品器材局.关于印发《抗菌药物临床应用指导原则(2015 年版)》的通知[S].国卫办医发〔2015〕43号.2015-07-24.
[7] Walker AJ,Curtis HJ,Goldacre B.Impact of Chief Medical Officer activity on prescribing of antibiotics in England,an interrupted time series analysis[J].J Antimicrob Chemother,2019,74(4):1133-1136.
[8] 国家卫生健康委医政医管局.2021年国家医疗质量安全改进目标[J].中国卫生质量管理,2021,28(4):15.
[9] 范峥,刘洋,韩丽娟,等.2018年北京市27家三级中医医院抗菌药物使用情况分析[J].中国医院用药评价与分析,2020,20(12):1493-1496.
[10] 陈楚钦,杨思芸,李娟,等.PDCA循环法用于抗菌 药物精细化管理效果分析[J].中国药业,2020,29(20):32-34.
[11] 陈科,樊菲菲.临床感染标本的病原菌分布及耐药性分析[J].临床急诊杂志,2021,22(7):463-468.
[12] 林佳冰,高晓东,崔扬文,等.上海市90所医院临床病原学标本送检及耐药菌检出现状分析[J].中华医院感染学杂志,2018,28(8):1162-1165.
[13] 邹兰科,邓忠天,陈丽娜.肺泡灌洗液和痰病原菌培养对下呼吸道感染的诊断价值分析[J].解放军预防医学杂志,2019,37(5):19-20.
[14] 田兴华,赵德军.2017年某县级三级综合医院住院患者病原学标本送检及主要病原菌耐药性分析[J].国外医药(抗生素分册),2020,41(2):134-138.
[15] 杭景仙,魏群,宋艳梅,等.医院感染多重耐药菌变化趋势及耐药分析[J].中国药业,2018,27(6):93-95.
[16] 刘剑烽.急诊病房下呼吸道感染患者各类标本细菌培养及药敏分析[J].临床急诊杂志,2020,21(2):125-134.
[17] Balinskaite V,Johnson AP,Holmes A,et al.The Impact of a National Antimicrobial Stewardship Program on Antibiotic Prescribing in Primary Care,An Interrupted Time Series Analysis[J].Clin Infect Dis,2019,69(2):227-232.
[18] 王锦,邵明鑫,王虹,等.不同专业重症监护病房多重耐药菌医院感染特征[J].中国感染控制杂志,2021,20(12):1126-1132.
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