住院手术患者抗生素使用状况分析

目的分析住院手术患者抗生素使用的规律与特征,为抗生素使用环节质量控制提供参考依据。方法利用医院信息系统中的药品使用及其费用信息,对住院手术患者使用抗生素状况进行。采用Visual FoxPro 6.0和SPSS 11.0软件进行统计分析。结果（1）520例住院手术患者中使用抗生素者占60.5%,其抗生素的使用时间呈偏态分布,平均使用时间11.8 d。（2）住院手术患者使用最多的是普通类抗生素（60.8%）,其次为贵重类（29.6%）,昂贵类抗生素的使用频率相对较低（9.6%）,但其费用却占有很大的比例（55.2%）;（3）抗生素联合使用：以单种（38.1%）和二联（41.3%）使用为主,三联及以上较少（20.6%）。二联用药主要分布在手术当日及术后1~6 d内,三联以上用药主要在手术当日及术后1~2 d内。（4）不同手术切口类型抗生素使用情况：Ⅱ、Ⅲ类切口昂贵类和贵重类抗生素的使用率高于Ⅰ类切口（P=0.000）,2组间平均用药天数和联合用药发生率差异均无统计学意义（P=0.44,P=0.270）。结论抗生素用药时间、联合用药可作为抗生素使用环节的控制重点,尤其是Ⅰ类切口患者术后预防性使用抗生素在联合用药及用药时间上存在不合理情况,应加强管理。     

Antimicrobial use and methicillin-resistant Staphylococcus aureus in a large nursing home

INTRODUCTION: In 1997, 18% of Staphylococcus aureus clinical isolates at the Wisconsin Veterans Home were resistant to methicillin. By 2002, 51% were resistant. METHODS: We determined the antibiotic sensitivity pattern of our methicillin-resistant S. aureus (MRSA) isolates as well as changes in utilization of specific antibiotics between two time periods. We reasoned that antibiotics with activity against methicillin-sensitive S. aureus (MSSA), but not MRSA, might be driving the overgrowth of MRSA. RESULTS: In our facility, MRSA is usually resistant to quinolones; MSSA is usually sensitive. Both MSSA and MRSA are usually sensitive to TMP-sulfa. An increased percentage of S. aureus resistant to methicillin (18%) was associated with a 42% increase in quinolone use and a 37% decrease in TMP-sulfa use. CONCLUSION: Our analysis and previous reports suggest that replacement of TMP-sulfa by quinolones could be selecting MRSA in our facility. This conclusion, however, is speculative, based on association, and requires confirmation.     

Challenges in Tracking and Reporting Antibiotic Use in Long-Term Care

The contemporary long-term care provider and interdisciplinary team are well aware of the recent focus on antibiotic use in their settings. Regulatory changes implemented by Centers for Medicare and Medicaid Services beginning in 2016 have required long-term care settings to look at antibiotic use in a more comprehensive way and to align their programs with the Centers for Disease Control and Prevention's Core Elements for Antibiotic Stewardship for Nursing Homes. As long-term care settings have worked to develop antibiotic stewardship programs over the past several years, there have been many discoveries about the processes involved in gathering data about antibiotic use and associated attributes, including dose, duration of therapy, and indication for use. Attempts to align these attributes with appropriateness may require integration of data elements from pharmacy records and the individual resident's electronic medical record. In this article, we systematically discuss relevant antibiotic use metrics, sources of antibiotic use data, collecting and reporting antibiotic use data, concluding with implications for policy, practice, and research. Only by measuring antibiotic use can we start to assess the effectiveness of antibiotic stewardship program to induce meaningful change in the care of residents in long-term care.     

2014-2015年全国抗菌药物处方点评数据分析

目的 通过数据评估全国部分三甲医院门/急诊抗菌药物应用的合理性。方法 抽取国际合理用药网络（INRUD）处方点评监测网中2014-2015年全国25个省（直辖市、自治区）78家网员单位上报的门/急诊应用抗菌药物处方。统计抗菌药物处方的基本信息,并对处方合理性进行分析。结果 共点评门/急诊抗菌药物处方447 894张,处方合格率从2014年91.52%上升至2015年93.08%,两年抗菌药物使用率相近,分别为11.72%及12.04%。2014及2015年门/急诊抗菌药物不合理处方主要为不适宜处方,包括适应证不适宜（32.42%,34.02%）及用法用量不适宜（24.22%,18.56%）两种类型。结论 门/急诊抗菌药物使用情况总体达标,但仍有个别地区未达到国家要求。不合理处方类型表明抗菌药物处方合理性仍有提高空间。     

Prevalence study of hospital-acquired infections in 14 Greek hospitals: planning from the local to the national surveillance level

A prevalence study of hospital-acquired infections (HAI) was carried out in 14 of 112 Greek hospitals (15.7%), scattered throughout Greece. Five of seven Greek university hospitals and nine regional hospitals participated in the one-day study, and 3925 hospitalized patients (10.5% of the total hospital beds in Greece) were recorded. The aim of this project was to organize a surveillance of HAI with the participation of the greatest possible number of Greek hospitals, transferring the experience from the local Cretan infection control network in an effort to create a nationwide network. Special attention was paid to recruit all Greek university hospitals in our attempt to expand the study base. Co-ordination of the participating centres, education of the infection control teams on surveillance methods, preparation of agreed definitions, and elaboration of the protocol for the collection of the data were the major objectives of this study. The difficulties, however, were limited resources and the lack of skilled personnel. The overall prevalence of HAI was found to be 9.3%. The most common HAI recorded involved lower respiratory tract infections (30.3%), followed by urinary tract infections (22.7%), bloodstream infections (15.8%), and surgical site infections (14.8%). The greatest prevalence rate was found in the adult ICU (48.4%), followed by the neonatal ICU (30.3%). The duration of hospitalization, the number of operations, the total number of used devices and invasive procedures were significantly correlated with HAI. Positive cultures were found in 51.5% of the cases. The most frequently isolated micro-organisms were: Pseudomonas aeruginosa (16.6%), Escherichia coli (10.8%), Klebsiella pneumoniae (10.3%), Staphylococcus epidermidis (8.1%) and Staphylococcus aureus (7.6%). The administration of antibiotics was also recorded. The prevalence of antibiotic use was 51.4%.     

医院2011年抗菌药物使用分析

目的 分析医院2011年抗菌药物使用情况,总结当前抗菌药物临床应用现象,为临床合理用药提供指导,有效降低细菌耐药性的产生,加强医院感染控制.方法 随机抽取医院2011年抗菌药物药品的出库记录,对抗菌药物种类和药品进行排序.结果 共纳入15 788份处方,2011年医院使用排名前5位的抗菌药物种类为喹诺酮类、头孢菌素类、青霉素类、硝基咪唑类和大环内酯类,分别占24.18％、15.96％、11.71％、10.95％、8.77％;使用数量排名前10位的抗菌药物为左氧氟沙星、阿莫西林、甲硝唑和头孢哌酮、阿奇霉素、头孢吡肟、头孢丙烯、头孢地尼、哌拉西林/舒巴坦、克拉霉素,分别占21.71％、8.04 ％、4.71％、4.29％、3.86％、3.20％、2.44％、2.00％、1.64％、1.37％.结论 喹诺酮类和头孢菌素类在医院使用较为普遍,青霉素类抗菌药物仍然占有很大比例,临床应该根据药敏试验的结果,合理选择有效的抗菌药物,避免经验性用药.     

降钙素原在慢性阻塞性肺疾病急性加重期优化抗生素使用的意义

目的评价降钙素原在慢性阻塞性肺疾病急性加重期(AECOPD)优化抗生素使用的临床意义。方法选择从2012年10月至2013年12月于我院就诊的100例AECOPD患者,随机分为试验组50例和对照组50例,对照组按照患者症状、抗生素使用指南和医生经验使用抗生素,试验组采用电化学发光法分别于患者治疗第1、4、7、10 d检测降钙素原(PCT),根据血清PCT≥0.25μg/L为截断值,使用抗生素,血清PCT<0.25μg/L不使用或停用抗生素。观察两组患者的抗生素使用情况,患者的平均住院时间,临床治疗有效率及二重感染的发生率。结果试验组患者的抗生素使用率为70.0%,对照组患者的抗生素使用率为88.0%,两组患者的抗生素使用率比较,差异有统计学意义(χ2=4.8825,P=0.0271)。试验组患者抗生素使用10天以上的发生率明显低于对照组,差异也有统计学意义(χ2=4.3738,P=0.0365)。试验组患者的平均住院时间为(12.4±2.6)d,对照组患者的平均住院时间为(16.7±3.3)d,两组患者平均住院时间比较,差异有统计学意义(t=7.2374,P=0.0000)。试验组患者的临床治疗有效率为90.0%,对照组患者的临床治疗有效率为84.0%,两组患者临床治疗有效率比较,差异无明显统计学意义(χ2=0.7958,P=0.3724)。试验组患者的二重感染率为4.0%,对照组患者的二重感染率为20.0%,两组患者二重感染率比较,差异有统计学意义(χ2=6.0606,P=0.0138)。结论降钙素原在评价AECOPD是否使用抗生素时有一定的指导作用,可以明显缩短抗生素的使用时间和使用率,在保证临床疗效的同时降低二重感染率。     

中国5所高校大学生抗生素认知、使用及教育需求调查分析

目的 了解中国高校大学生对抗生素的认知和使用现状及教育需求,为有针对性地开展合理用药健康教育和健康促进活动提供科学依据。方法 2017年5—7月采用分层抽样方法抽取北京、河北、广西5所高校2 000名在校大学生进行问卷调查。结果 大学生抗生素知识的总知晓率为66.7%。男生、医学专业、大四年级、一流大学建设高校、城市生源的学生知晓率高于其他组别,差异均有统计学意义(均P<0.05)。抗生素使用行为总正确率为64.1%,医学生(68.9%)高于非医学生(62.5%)(χ²=46.073,P<0.001),一流大学建设高校学生(66.2%)高于普通高校学生(59.6%)(χ²=41.001,P<0.001)。大学生希望通过医务人员(45.4%)、网络(11.9%)、医学书刊(9.7%)等途径获得抗生素使用方法(70.8%)和注意事项(81.4%)等知识。结论 大学生对抗生素的认知存在误区和不合理使用行为,应加强大学生医药知识教育,养成规范合理的用药习惯。     

3436张门诊处方点评与分析

目的 了解南京大学医院门诊处方特点及不合理用药情况,以加强医院处方规范化管理,促进临床合理用药。方法 采用回顾性分析方法,按简单随机方法抽取2018年1月—2018年12月南京大学医院3 436张门诊电子处方,进行点评和分析。结果 3 436张门诊处方中,每张处方平均开具2.81种药物,平均每张处方开具药品140.77元,全部使用药品通用名,使用抗菌药物处方达20%,使用注射剂的处方达4.3%,基本药物使用数占总药品数达50.93%,合理处方百分率为95.66%;不合理处方149张,主要表现为不规范处方、用药不适宜处方及超常处方。结论 医院门诊处方存在一些不合理的现象,应持续开展并加强处方点评工作,进一步降低抗菌药物使用率和单张处方金额,促进临床合理用药。     

湖北省农村医疗机构门诊合理用药指标调研

目的：了解湖北省农村地区医疗机构门诊合理用药处方指标现状。方法：结合世界卫生组织推荐的合理用药指标,对湖北省农村地区医疗机构门诊患者用药情况进行回顾性调查和研究。结果：单张处方平均用药数为2．52种,抗生素使用率为33．38％,含激素处方比例为6．09％,含针剂处方比例为50％,处方通用名使用率为56．61％,基本药物使用率为71．75％o,处方平均药品费用为42元。结论：湖北省农村地区医疗机构合理用药指标现状不够理想,有待进一步干预。     

纳米银妇女外用抗菌器生物学评价方法的初探

钠米银妇女外用抗菌器划归为医疗器械三类管理,属于对其安全性、有效性必须严格控制的医疗器械。该产品目前没有国家标准和行业标准．其生物学评价主要是参考GB／T16886《医疗器械生物学评价实施指南》,为了便于有效地控制该产品的安全性．有必要建立该产品的生物学评价项目和方法。     

Prevalence of hospital-acquired infection in a Lithuanian hospital

A prevalence survey in the biggest Lithuanian hospital was undertaken as part of the hospital infection control programme in Lithuania, in collaboration with Statens Seruminstitut, Denmark, to introduce modern methods and technologies in infection control. It aimed to test the methodology of prevalence studies identifying features of community- and hospitalacquired infections, use of clinical microbiology and antibiotics. It was found that 27·3% of all patients had an infection at the time of the survey. The prevalence rate of community-acquired infection (CAI) was 20·5% and of hospital-acquired infection (HAI), 9·2%. Almost one third of all HAI were acquired in other hospitals but still active at the time of the survey. HAIs were more prevalent in children (14·9%) than in adult patients (7·7%). The prevalence of HAI varied from 1·0% in neurological departments to 61·5% in the burns unit. Respiratory tract infections were the most common accounting up to 49·1% of all HAI and 28·3% of CAI. At the time of survey 26·0% of patients were receiving antibiotic treatment although more than one third of these were recorded as having no infection. Microbiological investigations were performed in 41·1% cases of HI. In this hospital, the survey data indicated an array of preventive priorities which will be exploited during the current hospital infection control programme. A national prevalence study is planned using the experience gained.     

浅议控制泰能使用的管理体会

目的采取有效措施控制不合理使用碳青霉烯类抗生素亚胺培南/西司他丁(泰能)。方法医院成立“抗菌药物合理应用指导小组”,须经该组专家批准,临床科室方可使用泰能。结果2004年10月-2005年12月使用泰能的量比2004年1-9月减少64瓶。批准使用泰能的20例患者均为严重感染,其中11例为经验性用药,9例有细菌学证据。医院分离的部分铜绿假单胞菌、醋酸钙/鲍曼不动杆菌仅对亚胺培南敏感。已发现耐亚胺培南菌株。结论严格控制泰能使用可提高其治疗的针对性,提高疗效,延长其使用时间。