上海交通大学学报（医学版） ›› 2024, Vol. 44 ›› Issue (3): 365-372.doi: 10.3969/j.issn.1674-8115.2024.03.009
• 论著 · 公共卫生 • 上一篇
王珂璇1(
), 刘芳1, 涂佳佳1, 茅一萍1,2()
收稿日期:2023-11-15
接受日期:2024-01-19
出版日期:2024-03-28
发布日期:2024-04-29
通讯作者:
茅一萍
E-mail:wkxnjmu@163.com;385524376@163.com
作者简介:王珂璇（1999—），女，硕士生；电子信箱：wkxnjmu@163.com。
基金资助:
WANG Kexuan1(), LIU Fang1, TU Jiajia1, MAO Yiping1,2()
Received:2023-11-15
Accepted:2024-01-19
Online:2024-03-28
Published:2024-04-29
Contact:
MAO Yiping
E-mail:wkxnjmu@163.com;385524376@163.com
Supported by:摘要：
目的·了解江苏省某三甲医院抗菌药物使用的变化，为医院抗菌药物管理的改进提供参考。方法·采用断面时点流行病学调查方法分别于2019年10月16日和2022年9月15日对徐州医科大学附属医院抗菌药物使用及医院感染情况进行调查。相关数据应用Excel 16.0进行汇总，使用SPSS 26.0软件进行数据分析，使用率、构成比描述相关数据，比较性分析采用χ2检验。结果·2019年共纳入患者数474人，调查当天患者抗菌药物使用率为48.1%；2022年共纳入患者数484人，调查当天患者抗菌药物使用率为33.5%。与2019年相比，2022年住院患者抗菌药物使用率有所降低。单用一种抗菌药物使用率由38.6%上升至82.7%（χ2=75.182，P=0.000），二联使用率由40.8%降为14.2%（χ2=32.048，P=0.000），四联使用率由14.0%降为0（χ2=24.769，P=0.000）。2019年与2022年手术预防抗菌药物单联使用率分别为61.5%、88.1%，手术预防抗菌药物使用为两种及以上的分别为38.5%、11.9%，2022年手术预防抗菌药物单联使用率高于2019年（χ2=27.297，P=0.000）；抗菌药物使用有用药记录率由4.0%上升至97.8%（χ2=695.523，P=0.000），抗菌药物使用有停药记录率由22.4%上升至91.0%（χ2=468.698，P=0.000），临床医生经验性使用抗菌药物率由47.3%上下降至35.8%（χ2=260.038，P=0.000），抗菌药物使用基于炎症指标率由18.9%上升至27.0%（χ2=505.637，P=0.000），抗菌药物使用遵循指南率由88.6%上升至92.1%（χ2=464.573，P=0.000）；2019年与2022年医院感染类型最多的均为肺炎，分别占64.7%和81.0%。结论·医院抗菌药物管理水平稳中向好，医护人员对抗菌药物使用的规范性有所提高。医院管理者应完善抗菌药物合理使用信息化建设，强调部门协作，共同制定工作计划，提高抗菌药物合理使用率，提升患者就诊满意度。
中图分类号:
王珂璇, 刘芳, 涂佳佳, 茅一萍. 基于断面时点流行病学调查方法探究医院抗菌药物的使用[J]. 上海交通大学学报（医学版）, 2024, 44(3): 365-372.
WANG Kexuan, LIU Fang, TU Jiajia, MAO Yiping. Exploration of the use of antibiotics in a hospital based on point prevalence survey[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(3): 365-372.
| Usage of antimicrobial agents | 2019 (n=474) | 2022 (n=484) | χ2 value | P value |
|---|---|---|---|---|
| Antimicrobial usage on the day of PPS/n(%) | 228 (48.1) | 162 (33.5) | 21.336 | 0.000 |
| Surgical prophylactic medication/n(%) | 109 (77.3) | 143 (76.9) | 4.356 | 0.150 |
表1 2019、2022年调查时点抗菌药物使用情况变化表
Tab 1 Changes in antimicrobial usage at the survey points in 2019 and 2022
| Usage of antimicrobial agents | 2019 (n=474) | 2022 (n=484) | χ2 value | P value |
|---|---|---|---|---|
| Antimicrobial usage on the day of PPS/n(%) | 228 (48.1) | 162 (33.5) | 21.336 | 0.000 |
| Surgical prophylactic medication/n(%) | 109 (77.3) | 143 (76.9) | 4.356 | 0.150 |
| Antimicrobial usage on the day of PPS | 2019 (n=228) | 2022 (n=162) | χ2 value | P value |
|---|---|---|---|---|
| Usage of monotherapy/n(%) | 88 (38.6) | 134 (82.7) | 75.182 | 0.000 |
| Dual usage/n(%) | 93 (40.8) | 23 (14.2) | 32.048 | 0.000 |
| Triple usage/n(%) | 15 (6.6) | 5 (3.1) | 2.374 | 0.123 |
| ≥Quadruple therapy/n(%) | 32 (14.0) | 0 (0) | 24.769 | 0.000 |
表2 PPS调查当日抗菌药物联合使用情况
Tab 2 Combined use of antibiotics on the day of PPS survey
| Antimicrobial usage on the day of PPS | 2019 (n=228) | 2022 (n=162) | χ2 value | P value |
|---|---|---|---|---|
| Usage of monotherapy/n(%) | 88 (38.6) | 134 (82.7) | 75.182 | 0.000 |
| Dual usage/n(%) | 93 (40.8) | 23 (14.2) | 32.048 | 0.000 |
| Triple usage/n(%) | 15 (6.6) | 5 (3.1) | 2.374 | 0.123 |
| ≥Quadruple therapy/n(%) | 32 (14.0) | 0 (0) | 24.769 | 0.000 |
| Usage of prophylactic antibiotics for surgery | 2019 (n=109) | 2022 (n=143) | χ2 value | P value |
|---|---|---|---|---|
| Usage of monotherapy/n(%) | 67 (61.5) | 126 (88.1) | 27.297 | 0.000 |
| ≥Dual usage/n(%) | 42 (38.5) | 17 (11.9) | 1.421 | 0.532 |
表3 手术预防性应用抗菌药物使用情况
Tab 3 Usage of prophylactic antibiotics for surgery
| Usage of prophylactic antibiotics for surgery | 2019 (n=109) | 2022 (n=143) | χ2 value | P value |
|---|---|---|---|---|
| Usage of monotherapy/n(%) | 67 (61.5) | 126 (88.1) | 27.297 | 0.000 |
| ≥Dual usage/n(%) | 42 (38.5) | 17 (11.9) | 1.421 | 0.532 |
| Normative usage of antibiotics | 2019 (n=402) | 2022 (n=355) | χ2 value | P value |
|---|---|---|---|---|
| Medication record/n(%) | 16 (4.0) | 347 (97.8) | 695.523 | 0.000 |
| Documented discontinuation/n(%) | 90 (22.4) | 323 (91.0) | 468.698 | 0.000 |
| Empirical usage/n(%) | 190 (47.3) | 127 (35.8) | 260.038 | 0.000 |
| Treatment based on inflammatory markers/n(%) | 76 (18.9) | 96 (27.0) | 505.637 | 0.000 |
| Adherence to medication guidelines/n(%) | ||||
| Compliance | 356 (88.6) | 327 (92.1) | 464.573 | 0.000 |
| Non-compliance | 39 (9.7) | 25 (7.0) | 456.735 | 0.000 |
| No national guidelines for specific indications | 7 (1.7) | 3 (0.9) | 528.805 | 0.000 |
表4 抗菌药物使用规范性变化
Tab 4 Normative changes in the use of antibiotics
| Normative usage of antibiotics | 2019 (n=402) | 2022 (n=355) | χ2 value | P value |
|---|---|---|---|---|
| Medication record/n(%) | 16 (4.0) | 347 (97.8) | 695.523 | 0.000 |
| Documented discontinuation/n(%) | 90 (22.4) | 323 (91.0) | 468.698 | 0.000 |
| Empirical usage/n(%) | 190 (47.3) | 127 (35.8) | 260.038 | 0.000 |
| Treatment based on inflammatory markers/n(%) | 76 (18.9) | 96 (27.0) | 505.637 | 0.000 |
| Adherence to medication guidelines/n(%) | ||||
| Compliance | 356 (88.6) | 327 (92.1) | 464.573 | 0.000 |
| Non-compliance | 39 (9.7) | 25 (7.0) | 456.735 | 0.000 |
| No national guidelines for specific indications | 7 (1.7) | 3 (0.9) | 528.805 | 0.000 |
图1 2019年与2022年抗菌药物使用种类所占比例
Fig 1 Proportion of types of antibiotics used in 2019 and 2022
| Type of HAI | 2019 (n=17) | 2022 (n=21) |
|---|---|---|
| Pneumonia | 11 (64.7) | 17 (81.0) |
| Urinary tract infection | 0 (0) | 2 (9.5) |
| Eye, ear, nose, throat or mouth infections | 2 (11.8) | 0 (0) |
| Lower respiratory tract infections other than pneumonia | 2 (11.8) | 0 (0) |
| surgical site infection | 1 (5.9) | 0 (0) |
| Bloodstream Infections (Laboratory confirmation) | 1 (5.9) | 1 (4.8) |
| Catheter-related infections in peripheral vessels | 0 (0) | 1 (4.8) |
表5 2019、2022年医院感染情况
Tab 5 Nosocomial infection in 2019 and 2022
| Type of HAI | 2019 (n=17) | 2022 (n=21) |
|---|---|---|
| Pneumonia | 11 (64.7) | 17 (81.0) |
| Urinary tract infection | 0 (0) | 2 (9.5) |
| Eye, ear, nose, throat or mouth infections | 2 (11.8) | 0 (0) |
| Lower respiratory tract infections other than pneumonia | 2 (11.8) | 0 (0) |
| surgical site infection | 1 (5.9) | 0 (0) |
| Bloodstream Infections (Laboratory confirmation) | 1 (5.9) | 1 (4.8) |
| Catheter-related infections in peripheral vessels | 0 (0) | 1 (4.8) |
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