摘要
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2947例,其中实施前病例1105例,实施后病例1842例。出院诊断中涉及感染病例2643例,占89.7%,其中实施前963例(占87.1%),实施后1680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。
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 2947 discharged patients were included,1105 of whom were pre-implementation cases and 1842 were post-implementation cases.Among the discharged diagnosis,2643 were infection cases(89.7%),including 963 pre-implementation cases(87.1%)and 1680 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.
作者
夏小哲
李园园
蒋娟
李春辉
卢敬梅
戴智勇
陈浩
XIA Xiao-zhe;LI Yuan-yuan;JIANG Juan;LI Chun-hui;LU Jing-mei;DAI Zhi-yong;CHEN Hao(Department of Medical Administration,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Pulmonary and Critical Care Medicine,Xiangya Hospital,Central South University,Changsha 410008,China;Center for Healthcare-associated Infection Control,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Pharmacy,Xiangya Hospital,Central South University,Changsha 410008,China;Office of Hospital,Xiangya Hospital,Central South University,Changsha 410008,China)
出处
《中国感染控制杂志》
CAS
CSCD
北大核心
2023年第6期695-700,共6页
Chinese Journal of Infection Control
基金
国家自然科学基金面上项目(82170041)
湖南省卫生健康委员会委托课题(2021)。
关键词
呼吸系统疾病
危重症
精准诊疗体系
抗菌药物科学化管理模式
respiratory system disease
critical care medicine
precise diagnosis and treatment system
antimicrobial stewardship
