呼吸危重症精准诊疗体系在抗菌药物应用管理中的价值探索

目的 构建呼吸危重症精准诊疗体系，探索该体系对促进抗菌药物合理使用的价值，从源头上促进呼吸危重症抗菌药物合理使用。 方法 以2012—2021年中南大学湘雅医院呼吸重症监护专科出院病例为研究对象，将抗菌药物科学化管理模式融入呼吸危重症精准诊疗体系，对比该体系实施前后抗菌药物使用情况。 结果 共纳入出院病例2 947例，其中实施前病例1 105例，实施后病例1 842例。出院诊断中涉及感染病例2 643例，占89.7%，其中实施前963例(占87.1%)，实施后1 680例(占91.2%)。实施后在感染病例占比增加的情况下，抗菌药物使用率较实施前下降2.9%(97.0% VS 94.2%，P＜0.001)；抗菌药物使用强度较实施前下降12.4%(244.4 DDDs VS 214.1 DDDs)，特殊使用级抗菌药物使用强度较实施前下降14.4%(131.0 DDDs VS 112.2 DDDs)，均由高位波动转为线性下降(P＜0.001)。 结论 呼吸危重症精准诊疗体系有效促进抗菌药物合理、精准使用，临床诊疗团队是该体系的核心，新兴诊疗技术发挥重要作用。

The value of precise diagnosis and treatment system for pulmonary and critical care medicine in the management of antimicrobial usage

Objective To develop a precise diagnosis and treatment system for pulmonary and critical care medicine, explore the value of the system in promoting the rational antimicrobial use, and promote the rational use of antimicrobial agents from the source. Methods Patients discharged from the department of pulmonary and critical care medicine of Xiangya Hospital of Central South University from 2012 to 2021 were taken as the research objects. Antimicrobial stewardship (AMS) was integrated into the precise diagnosis and treatment system for pulmonary and critical care medicine, and antimicrobial use before and after the implementation of the system were compared. Results A total of 2 947 discharged patients were included, 1 105 of whom were pre-implementation cases and 1 842 were post-implementation cases. Among the discharged diagnosis, 2 643 were infection cases (89.7%), including 963 pre-implementation cases (87.1%) and 1 680 post-implementation cases (91.2%). Despite an increase in the proportion of infected cases after implementation, antimicrobial use decreased by 2.9% compared to before implementation cases (97.0% vs 94.2%, P < 0.001). Compared to the pre-implementation period, the intensity of antimicrobial use decreased by 12.4% (244.4 DDDs vs 214.1 DDDs) and the intensity of special-use antimicrobial agents decreased by 14.4% (131.0 DDDs vs 112.2 DDDs), both shifting from high fluctuations to linear declines (P < 0.001). Conclusion The precise diagnosis and treatment system for pulmonary and critical care medicine effectively promotes the rational and precise use of antimicrobial agents, with the clinical treatment team as the core of the system, and emerging diagnostic and treatment technologies playing an important role.