AMS对消化内镜围操作期预防性使用抗菌药物的干预效果

目的探讨抗菌药物科学化管理(AMS)策略对消化内镜诊疗操作患者围操作期抗菌药物预防使用的干预效果。方法以某附属医院2019年1—6月行消化内镜诊疗操作的1 006例患者为研究对象,采用AMS策略对患者围操作期预防使用抗菌药物进行管理和干预,措施包括成立组织、完善制度、优化信息系统、宣教与培训、持续干预和监督等。以2017年1—6月行消化内镜诊疗操作的822例患者为对照组,对比分析两组患者围操作期预防性抗菌药物使用率、抗菌药物使用强度(AUD)、抗菌药物品种、联合用药以及用药时长的变化;同时比较预防性抗菌药物不合理应用情况以及术后感染情况。结果干预前预防性抗菌药物使用率为24.82%(204/822),干预后为17.10%(172/1 006),干预前后比较,差异具有统计学意义(P0.001);AUD方面,干预后为2.18,低于干预前的14.95;联合用药比例、用药时长与干预前相比亦明显下降。AMS策略实施后,抗菌药物预防性应用的不合理率低于实施前(P0.001);而操作后感染发生率则无明显变化(P0.05)。结论 AMS策略能够优化消化内镜围操作期预防性抗菌药物的应用。

Intervention efficacy of antimicrobial stewardship on antimicrobial prophylaxis during peri-operative period of digestive endoscopy

Objective To explore the intervention efficacy of antimicrobial stewardship (AMS) on antimicrobial prophylaxis during peri-operative period of digestive endoscopy of patients. Methods A total of 1 006 patients who underwent digestive endoscopy in a hospital from January to June 2019 were included in the study, AMS strategy was adopted to manage antimicrobial prophylaxis during peri-operative period, these measures included establishing organization, improving policies, optimizing hospital information system, conducting education and training, as well as performing continuous intervention and supervision. 822 patients who underwent digestive endoscopy from January to June 2017 were as control group, changes in peri-operative prophylactic antimicrobial use rate, antimicrobial use density (AUD), as well as varieties, combination use and duration of antimicrobial use between two groups of patients were compared and analyzed; irrational use of antimicrobial agents and post-operative infection between two groups were also compared. Results Prophylactic antimicrobial use rate before and after intervention were 24.82% (204/822) and 17.10% (172/1 006) respectively, difference before and after intervention was statistically significant (P < 0.001); AUD was 2.18 after intervention, which was lower than 14.95 before intervention; proportion and duration of combined medication were also significantly lower than those before intervention. After the implementation of AMS strategy, irrational use rate of antimicrobial agents was lower than that before the implementation (P < 0.001); there was no significant change in the incidence of infection after operation (P>0.05). Conclusion AMS strategy can optimize antimicrobial prophylaxis during peri-operative period of digestive endoscopy.