医院感染管理科参与抗菌药物应用管理的成效

目的 观察医院感染管理科积极参与抗菌药物临床应用管理的作用。方法 比较医院感染管理科积极参与管理前（2012—2014年）、管理后（2015—2017年）的抗菌药物临床应用管理评价指标的变化情况。结果 医院感染管理科积极参与抗菌药物应用管理后，住院患者抗菌药物使用率由积极管理前17.18%下降至15.24%，特殊级抗菌药物使用率由1.45%下降至1.02%、接受特殊使用级抗菌药物治疗的住院患者抗菌药物使用前微生物送检率由87.12%上升至91.15%。积极管理后Ⅰ类切口手术患者预防性使用抗菌药物使用率为10.86%，术前0.5~1 h给药率为89.32%，预防性使用疗程<24 h患者比率为86.77%，均高于积极管理前的8.74%、75.87%及57.81%，差异均有统计学意义（均P<0.001）。积极管理前Ⅰ、Ⅱ、Ⅲ类切口感染率分别为0.27%、0.92%、1.29%，积极管理后Ⅰ、Ⅱ、Ⅲ类切口感染率分别为0.20%、0.67%、4.42%。Ⅱ类切口感染率积极管理前后比较，差异有统计学意义（P=0.011）。结论 医院感染管理科积极参与抗菌药物应用管理能使抗菌药物临床应用管理评价指标得到明显改善，可促进抗菌药物合理应用。

Effectiveness of department of healthcare-associated infection management participating in antimicrobial application management

Objective To observe the effectiveness of department of healthcare-associated infection(HAI) management actively participating in the management of clinical application of antimicrobial agents. Methods Changes in evaluation index of clinical application management of antimicrobial agents before(2012-2014) and after (2015-2017) department of HAI management actively participated in management was compared. Results After department of HAI management actively participated in management of clinical application of antimicrobial agents, the utilization rate of antimicrobial agents in hospitalized patients decreased from 17.18% before active management to 15.24%, the utilization rate of special used antimicrobial agents decreased from 1.45% to 1.02%, microbial detection rate before antimicrobial use in patients receiving special grade antimicrobial agents increased from 87.12% to 91.15%. After active management, antimicrobial prophylaxis rate in patients undergoing class Ⅰ incision operation was 10.86%, administration rate 0.5-1 hour before operation was 89.32%, 86.77% of patients received<24 hour course of antimicrobial prophylaxis, all were higher than 8.74%, 75.87%, and 57.81% respectively before active participation, differences were all statistically significant (all P<0.001). Before active management, surgical site infection(SSI) rates of class I, II, and III incision were 0.27%, 0.92%, and 1.29% respectively, after active management, SSI rates were 0.20%,0.67%,and 4.42% respectively. There was significant difference in SSI rate of class II incision before and after active management (P=0.011). Conclusion Active participation of the department of HAI management in antimicrobial management can obviously improve the evaluation index of clinical application of antimicrobial agents, and promote the rational use of antimicrobial agents.