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| 临床药师主导的抗菌药物科学化管理有效降低妇儿专科医院抗菌药
物使用强度 |
| 杨金连,邓后亮,李晓君,欧阳珊,岑菡婧,梁倩莹,魏媛怡,卢嘉丽,吴玮哲,肖楚瑶,李丽娟,曹晓均,丁春光,
赵丹洋,郭巧芝,周轶,莫小兰 |
| (广州医科大学附属妇女儿童医疗中心,广州 510623) |
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| 摘要: |
| 目的:探讨以临床药师为主导的多学科抗菌药物科学化管理(AMS)在降低妇儿专科医院抗菌药物使用强度(AUD)中的
成效。方法:开展临床药师主导的AMS 项目,并应用计划-执行-检查-行动(PDCA)方法,收集AUD、住院患者抗菌药物使用率、
抗菌药物费用占比、特殊使用级抗菌药物用量占比、抗菌药物治疗前病原学送检率等数据,并评价项目实施效果。结果:AMS
项目实施前后比较,从2020 年至2023 年住院患者AUD 由24. 34 限定日剂量数(DDDs)下降至16. 65 DDDs,住院患者抗菌药物
使用率由42. 60%降至37. 28%,抗菌药物费用占比由16. 87%降至9. 41%,抗菌药物治疗前病原学送检率由64. 64%升至
81. 94%,特殊使用级抗菌药物用量占比由32. 65%降至24. 82%,医院感染例次率由0. 96%降至0. 88%,多重耐药菌检出率由
19. 23%降至13. 26%,但手术部位感染发生率比较差异无统计学意义(P =0. 512)。中断时间序列分析(ITS)显示,从短期效应
看,AMS 项目的实施显著降低了住院患者AUD、抗菌药物费用占比、特殊使用级抗菌药物用量占比,提高了抗菌药物治疗前病
原学送检率;从长期效应看,AMS 项目的实施有利于降低抗菌药物费用占比和特殊使用级抗菌药物用量占比。此外,AMS 项目
的实施未对住院患者抗菌药物使用率产生明显的短期或长期效应。结论:临床药师主导基于PDCA 的AMS 管理模式行之有
效,能促进妇儿专科医院抗菌药物的合理应用。 |
| 关键词: PDCA 循环 抗菌药物使用强度 妇儿专科医院 合理用药 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2026.02.005 |
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| 基金项目:基金项目:吴阶平医学基金会临床科研专项资助基金,编号320. 6750. 2022-20-26;广州市科学技术局2023 年重点研发计划项目(2023 年度
农业和社会发展科技专题),编号SL2022B03J01382;中国药学会医院药学专委会医院药学青年人才项目,编号CPA-Z05-ZC-2021-003。 |
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| Clinical Pharmacist-Led Antimicrobial Stewardship in Effective Reduction of Antibacterial Use Density inthe Women and Children’s Hospital |
| Yang Jinlian, Deng Houliang, Li Xiaojun, Ouyang Shan, Cen Hanjing, Liang Qianying, Wei Yuanyi, Lu Jiali,
Wu Weizhe, Xiao Chuyao, Li Lijuan, Cao Xiaojun, Ding Chunguang, Zhao Danyang, Guo Qiaozhi, Zhou Yi, Mo
Xiaolan |
| (Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China) |
| Abstract: |
| Objective: To explore the effectiveness of multidisciplinary antimicrobial stewardship (AMS) led by clinical pharmacists in
reducing the antibacterial use density (AUD) in the women and children’s hospital. Methods: A clinical pharmacist-led AMS project
was implemented, and the plan-do-check-act (PDCA) method was applied. The AUD, antimicrobial utilization rate in inpatients,
proportion of inpatient antibiotic costs, proportion of special-class antibiotics, and pathogen detection rate of inpatients before
antimicrobial therapy were collected to evaluate the effects. Results: Before and after the implementation of AMS project, AUD of
inpatients decreased from 24. 34 defined daily dose system (DDDs) to 16. 65 DDDs from 2020 to 2023, the antimicrobial utilization rate
in inpatients decreased from 42. 60% to 37. 28%, the proportion of inpatient antibiotic costs decreased from 16. 87% to 9. 41%, the
pathogen detection rate of inpatients before antimicrobial therapy increased from 64. 64% to 81. 94%, the proportion of special-class
antibiotics decreased from 32. 65% to 24. 82%, the hospital infection case rate decreased from 0. 96% to 0. 88%, the multidrug-resistant
organism detection rate decreased from 19. 23% to 13. 26%, but the difference of surgical site infection rate between two groups was not
statistically significant (P = 0. 512). Subsequent interrupted time series (ITS) analysis demonstrated that in the short term, the
implementation of AMS project significantly decreased the AUD, proportion of inpatient antibiotic costs, and proportion of special-class
antibiotics, but significantly increased the pathogen detection rate of inpatients before antimicrobial therapy. In the long term, the
implementation of AMS project was associated with a significant reduction in the proportion of inpatient antibiotic costs and proportion of
special-class antibiotics. Meanwhile, no significant short-term or long-term effects of the implementation of AMS project were observed
on antimicrobial utilization rate in inpatients. Conclusion: The AMS management model led by clinical pharmacists and based on PDCA
is effective in promoting the rational use of antibiotics in the women and children’s hospital. |
| Key words: PDCA cycle method antibacterial use density women and children’s hospital rational drug use |
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