“提高抗菌药物治疗前病原学送检率”专项行动三年改进效果追踪评价

Tracking and evaluation on the improvement efficacy of a 3-year special action of "Improving the pathogen detection rate before antimicrobial therapy"

摘要:

目的追踪评价连续三年推进"提高抗菌药物治疗前病原学送检率"专项行动的改进效果,为今后工作提供循证依据。方法收集2020—2023年某三级综合医院住院患者临床资料,以2020年基线调查结果为改进前组,2021—2023年持续推进专项行动改进目标为改进后组,采取完善信息系统、建立多部门协作机制、全员多层次培训宣教、规范医疗行为和病原学送检流程、强化监管效能等措施,动态追踪指标并及时跟进策略,通过医院感染信息系统开展监测并获取数据。应用R 4.1.3统计软件,比较两组指标的差异和不同年份数据变化趋势以评价改进成效。结果推进专项行动改进目标三年,治疗性抗菌药物使用率有所降低,且随年份变化呈下降趋势(P＜0.001)。抗菌药物治疗前病原学送检率由39.38%提高到85.40%,血培养送检率由14.11%提高到49.28%,限制级和特殊级抗菌药物治疗前病原学送检率分别由31.76%、55.97%增至92.11%、99.10%,联合使用重点药物前病原学送检率由83.09%增至97.74%,且均随着年份变化呈逐年增高趋势(均P＜0.001)。多重耐药菌检出率下降,耐碳青霉烯类肠杆菌目细菌(CRE)和耐甲氧西林金黄色葡萄球菌(MRSA)检出率呈下降趋势(P＜0.001)。医院感染诊断相关病原学送检率保持在90%以上,采集标本与感染部位相符率由73.26%提高到91.67%,且随着年份变化呈逐年增高趋势(P＜0.05),其中内科科室相符率最低,重症医学科相符率最高。结论连续三年持续推进专项行动改进目标,保持动态评估,大大提高了临床医务人员对病原学标本送检指征和时机的准确把握,规范了诊疗行为,从而引导临床正确、合理使用抗菌药物,减少医院细菌耐药的发生。

Abstract:

Objective To track and evaluate the improvement efficacy of a 3-year continuous implementation of special action of "Improving the pathogen detection rate before antimicrobial therapy", and provide evidence-based basis for future work. Methods Clinical data of inpatients in a tertiary comprehensive hospital from 2020 to 2023 were collected. The baseline survey result in 2020 was taken as the pre-improvement group, and the continuous implementation of special action improvement goal from 2021 to 2023 was as the post-improvement group. Measures were taken, including improving the information system, establishing a multi-department collaboration mechanism, providing multi-level training and education for all staff, standardizing medical behavior and pathogen detection processes, and strengthening supervision efficiency. Indicators were dynamically tracked and strategies were fo-llowed up promptly. Monitoring and data acquisition were carried out through the hospital infection information system. R 4.1.3 statistical software was adopted to compare the differences between two sets of indicators and the changing trends of data in different years, and the improvement efficacy was evaluated. Results After promoting the improvement goal of 3-year special action, the therapeutic antimicrobials usage rate decreased, presenting a downward trend with years (P<0.001). Pathogen detection rate before antimicrobial therapy increased from 39.38% to 85.40%; blood culture detection rate increased from 14.11% to 49.28%; pathogen detection rates before restricted and special antimicrobial therapy increased from 31.76% and 55.97% to 92.11% and 99.10%, respectively; pathogen detection rate before combined use of key antimicrobial agents increased from 83.09% to 97.74%, all presenting increasing trends year by year (all P<0.001). The detection rate of multidrug-resistant organisms decreased. Detection rates of carbapenem-resistant Enterobacterales (CRE) and methicillin-resistant Staphylococcus aureus (MRSA) presented downward trends (P<0.001). Healthcare-associated infection (HAI) diagnosis-related pathogen detection rate remained above 90%. Consistency rate between specimen collection and infection sites increased from 73.26% to 91.67%, with an increasing trend year by year (P<0.05). The internal medicine department had the lowest consistency rate, while the critical care medicine department had the highest consistency rate. Conclusion Three-year continuous promotion of the special action improvement goal and dynamic evaluation have greatly improved the clinical medical personnel’s capability in judging the indicators and detection timing of pathogen specimens accurately, standardized diagnosis and treatment behavior, and guided the correct and rational use of antimicrobial agents in clinical practice, thus reduced the occurrence of bacterial resistance in hospital.