| 刘洪峰,范秀英,朱峰.“四网一会”联动对某医院抗菌药物科学化管理及细菌耐药的影响分析[J].安徽医药,2023,27(10):2112-2116. |
| “四网一会”联动对某医院抗菌药物科学化管理及细菌耐药的影响分析 |
| Analysis of the influence of "four monitoring networks, one meeting" linkage on scientific management of antibiotics and bacterial resistance in a hospital |
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| DOI：10.3969/j.issn.1009-6469.2023.10.044 |
| 中文关键词: 抗菌药 药剂学管理 “四网一会” 科学化管理 细菌耐药 |
| 英文关键词: Anti-bacterial agents Pharmacy administration "Four monitoring networks, one meeting" Scientific management Bacterial resistance |
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| 中文摘要: |
| 目的通过“四网”监测信息和对某医院现场情况调研，综合分析、评价抗菌药物临床应用与管理、细菌耐药及医院感染控制相关工作的开展情况。方法 2021年 7月“全国细菌耐药监测网”“全国抗菌药物临床应用监测网”“全国真菌病监测网”“全国医院感染监控网”“中华医学会细菌感染与耐药防治分会”(简称“四网一会”)专家组通过现场走访、分组调研、病历讨论、问卷调查等多种方式，深入了解某医院在抗菌药物临床应用综合管理、抗菌药物临床使用、感染性疾病科建设、细菌耐药、医院感染监测等方面的工作情况，对某院的抗菌药物目录、微生物标本送检、临床合理应用及干预、科学化管理等方面进行综合评价提出改进意见。该院针对专家提出问题采取一系列科学化管理方式进行整改，并利用全国首创的手机版细菌耐药监测查询系统(Hui-net)监测耐药变迁，预防感控事件，指导抗菌药物管理，另外还通过优化抗菌药物目录、提高血培养等无菌标本送检率、开展抗菌药物管理多学科协作(AMS-MDT)活动、加强院感细节管理等一系列措施。结果通过科学化管理措施，使得全院抗菌药物使用强度、替加环素及碳青霉烯类使用强度明显降低，降幅分别为 19.94%(41.42/33.16)、 58.0%(0.62/0.26)和 18.57%(1.4/1.14)。细菌耐药率明显下降， MRSA、CRKPN和 CRPAE联动前分别为 53.28%(65/122)、56.13%(119/212)和 46.67%(35/75)，而联动后则分别下降到 40.91%(54/132)、30.05%(55/183)和 26.88%(25/93)；替加环素及碳青霉烯类抗菌药物使用率下降；痰液送检率降低(P<0.05)，科学化管理水平得以提升。结论“四网一会”联动活动对促进某医院进一步提高抗菌药物科学化管理水平，提高碳青霉烯类及替加环素等特殊抗菌药物的合理使用，减缓细菌耐药性产生积极影响，具有重要的指导意义。 |
| 英文摘要: |
| Objective To comprehensively analyze and evaluate the implementation of the clinical application and management ofantibacterial drugs, bacterial resistance and hospital infection control through the four networks monitoring information and the field investigation of a hospital.Methods In July 2021, a panel of experts from the "National Clinical Application Monitoring Network of Antibacterial Drugs" "National Bacterial Resistance Monitoring Network" "National Fungal Disease Monitoring Network" "National Hospital Infection Monitoring Network" and the "Chinese Medical Association Branch on Bacterial Infections and Resistance Prevention"(collectively known as "Four Networks and One Meeting") conducted on-site visits, group research, medical record discussions, andquestionnaire surveys to gain insight into the hospital′s work in areas such as comprehensive management of clinical antibiotic use,management of infectious diseases, bacterial resistance, and hospital infection monitoring. The panel provided recommendations for improvement in areas including the antibiotic catalog, microbial specimen testing, clinical rational use and intervention, and scientificmanagement. The hospital implemented a series of scientifically-based management approaches to address the issues raised by the experts. Furthermore, the hospital utilized the nation′s first mobile version bacterial resistance monitoring and query system (Hui-net) tomonitor resistance trends, prevent infection control incidents, and guide antibiotic management. Other measures included optimizingthe antibiotic catalog, improving the rate of blood culture and other sterile specimen testing, conducting multidisciplinary collaborationin antibiotic management (AMS-MDT) activities, and strengthening nosocomial infection details management.Results The implementation of scientific management measures led to a significant reduction in the overall intensity of antibiotic use in the hospital, as well asthe use of tigecycline and carbapenems, with reductions of 19.94% (41.42 / 33.16), 58.0% (0.62 /0.26), and 18.57% (1.4 /1.14), respectively. The bacterial resistance rates also showed a noticeable decline, with MRSA, CRKPN, and CRPAE rates before the cooperation being 53.28% (65/122), 56.13% (119/212), and 46.67% (35/75), respectively. After the cooperation, these rates decreased to 40.91% |
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