感染预防控制与抗菌药物管理协同降低细菌耐药水平的临床实践
作者:
作者单位:

1.上海市第一人民医院院感防控办公室, 上海 201620;2.上海市第一人民医院检验科, 上海 201620;3.上海市第一人民医院临床药学科, 上海 201620

作者简介:

通讯作者:

邹妮  E-mail: kathyzou76@163.com

中图分类号:

+2  R197.32]]>

基金项目:

上海市申康医院发展中心技术规范化管理和推广项目(SHDC22022211);上海市松江区科技攻关(医疗卫生类)项目(21SJKJGG94)


Clinical practice of collaboration of infection prevention and control and antimicrobial stewardship in reducing bacterial resistance
Author:
Affiliation:

1.Department of Healthcare-associated Infection Prevention and Control, Shanghai General Hospital, Shanghai 201620, China;2.Department of Laboratory Medicine, Shanghai General Hospital, Shanghai 201620, China;3.Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai 201620, China

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    摘要:

    目的 探讨医疗机构应用感染预防控制(IPC)与抗菌药物管理(AMS)的协同模式降低细菌耐药水平的效果。 方法 收集某院2015年1月1日—2022年12月31日所有住院患者医院感染管理、抗菌药物相关指标及多重耐药菌(MDRO)检出率, 评估IPC联合AMS协同模式的效果。 结果 与2015—2016年比较, 2021—2022年MDRO医院感染发病率从0.22%下降至0.16%(P<0.05), 住院患者抗菌药物使用强度从48.48下降至42.17, 抗菌药物使用率从49.45%下降至45.21%(P<0.05);Ⅰ类切口手术预防性抗菌药物使用率从48.62%下降至33.13%(P<0.05); 与2017—2018年比较, 2021—2022年抗菌药物治疗前病原学送检率从60.73%上升至72.18%(P<0.05)。与2015—2016年比较, 2021—2022年除耐万古霉素粪肠球菌检出率略有上升, 其余各类常见MDRO检出率均下降, 尤其是耐甲氧西林金黄色葡萄球菌、耐碳青霉烯类鲍曼不动杆菌、耐碳青霉烯类铜绿假单胞菌、产广谱β-内酰胺酶肺炎克雷伯菌、产广谱β-内酰胺酶大肠埃希菌、耐氟喹诺酮类大肠埃希菌, 差异均有统计学意义(均P<0.05)。 结论 采取IPC与AMS的协同模式, 可有效促进抗菌药物合理使用, 减少MDRO的产生和传播, 降低细菌耐药。

    Abstract:

    Objective To explore the effect of collaborative mode of adopting infection prevention and control (IPC) and antimicrobial stewardship (AMS) by medical institutions on reducing bacterial resistance. Methods Healthcare-associated infection (HAI) management and antimicrobial-related indicators, as well as multidrug-resis-tant organism (MDRO) detection rates of all hospitalized patients in a hospital from January 1, 2015 to December 31, 2022 were collected. The effectiveness of collaborative mode of IPC and AMS was evaluated. Results Compared with 2015-2016, the incidence of MDRO HAI in 2021-2022 decreased from 0.22% to 0.16% (P < 0.05), antimicrobial use density in hospitalized patients decreased from 48.48 to 42.17, antimicrobial use rate decreased from 49.45% to 45.21% (P < 0.05). The use rate of prophylactic antimicrobial agents in class Ⅰ incision surgery decreased from 48.62% to 33.13% (P < 0.05). Compared with 2017-2018, pathogen detection rate before antimicrobial therapy increased from 60.73% to 72.18% in 2021-2022 (P < 0.05). Compared with 2015-2016, except the detection rate of vancomycin-resistant Enterococcus faecalis slightly increased in 2021-2022, detection rates of other common MDRO decreased, especially methicillin-resistant Staphylococcus aureus, carbapenem-resistant Acinetobacter baumannii, carbapenem-resistant Pseudomonas aeruginosa, broad-spectrum β-lactamase-producing Klebsiella pneumoniae, broad-spectrum β-lactamase-producing Escherichia coli and fluoroquinolone-resistant Escherichia coli, differences were all statistically significant (all P < 0.05). Conclusion The collaborative mode of IPC and AMS can effectively promote the rational use of antimicrobial agents, decrease the occurrence and transmission of MDRO, and decrease bacterial resistance.

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邹妮,朱丹,王丹,等.感染预防控制与抗菌药物管理协同降低细菌耐药水平的临床实践[J]. 中国感染控制杂志,2024,23(7):860-867. DOI:10.12138/j. issn.1671-9638.20245028.
Ni ZOU, Dan ZHU, Dan WANG, et al. Clinical practice of collaboration of infection prevention and control and antimicrobial stewardship in reducing bacterial resistance[J]. Chin J Infect Control, 2024,23(7):860-867. DOI:10.12138/j. issn.1671-9638.20245028.

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  • 收稿日期:2023-05-28
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  • 在线发布日期: 2024-08-13
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