摘要
目的调查医院政策干预围手术期抗菌药物应用的成效及对颅内感染的影响,指导临床规范抗菌药物的使用及管理。方法回顾性调查2010年5-8月神经外科择期或限期手术患者91例作为对照组,2011年5-8月神经外科择期或限期手术患者102例作为干预组,对患者的基本资料、疾病诊断、手术情况、围手术期抗菌药物使用时间、种类选择以及颅内感染发生率、病原菌的变化进行分析。结果干预后围手术期抗菌药物使用时间缩短,手术前日给药从45.05%下降至12.75%,手术后抗菌药物使用1d从0升高至15.69%,使用2～3d,从26.37%升至56.86%,而使用8～10d,从34.07%下降至1.96%,使用>10d后,从21.98%下降至6.86%;抗菌药物使用种类选择更合理,二代头孢类抗菌药物使用增加,从7.24%升高至22.22%,三代头孢类抗菌药物使用减少,从6.34%下降至4.86%,哌拉西林/舒巴坦使用减少,从33.94%下降至25.69%,万古霉素类抗菌药物明显减少,从22.17%下降至2.78%;抗菌药物联合使用情况减少,围手术期使用一种抗菌药物增加,从20.88%升高至44.12%;颅内感染发生率无变化。结论依据《抗菌药物临床应用指导原则》和《围手术期预防应用抗菌药物指南》,根据实际情况制定明确细则,加强监督和管理,促进围手术期合理规范的应用抗菌药物,不会增加颅内感染的发生率。
OBJECTIVE To investigate the effectiveness of the administrative intervention in the use of antibiotics during the perioperative period and its effect on the intracranial infections so as to guide the reasonable clinical use of antibiotics. METHODS A total of 91patients who underwent the selective and limited neurosurgical operation from May to Aug 2010 were retrospectively investigated and set as the control group, and another 102 patients who underwent the selective or limited neurosurgical operation form May to Aug 2011 were chosen as the intervention group; the general data, diagnosis of disease, surgery situation, the dosage and usage of antibiotics during perioperative period, the incidence of intracranial infections and the species of pathogens were analyzed. RESULTS In intervention group, the dosage of antibiotics during perioperative period was decreased, the rate of cases who received antibiotic treatment the day before surgery day decreased from 45.05% to 12.75%, the rate of using antibiotics within 1 day after the operation increased from 0% to 15. 69%, the rate of using antibiotics within 2 or 3 days increased from 26.37% to 56.86%, however, the rate of using antibiotics within 8 to 10 days decreased from 34.07% to 1.96%, the rate of using antibiotics more than 10 days after the operation decreased from 21.98 ~ to 6.86 % ; the selection of the antibiotics tended to be more reasonable, the rate of using the second generation of cephalosporins increased from 7..24% to 22. 22%, the rate of using the third generation of cephalosporins decreased from 6.34 % to 4.86 %, the rate of using piperacillin/sulbactam decreased from 33.84% to 25.69%, the rate of using vancomycin decreased from 22.17% to 2.78%. The combination use of antibiotics decreased, the rate of using single drug increased from 20.88% to 44.12 %, there was no change in the incidenceof the intracranial infections. CONCLUSION According to the guidelines for the clinical application of antibiotics and the directions for prophylactic use of antibi
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2012年第23期5352-5354,共3页
Chinese Journal of Nosocomiology
关键词
干预
围手术期
抗菌药物
颅内感染
Intervention
Perioperative period
Antibiotics
Intracranial infection
