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基于多学科诊疗模式的我院肺结核患者碳青霉烯类药物使用管理
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| 篇名： | 基于多学科诊疗模式的我院肺结核患者碳青霉烯类药物使用管理 |
| TITLE： | Application Management of Carbapenems in Tuberculosis Patients of Our Hospital Based on Multi-disciplinary Team |
| 摘要： | 目的：为肺结核患者合理使用碳青霉烯类药物提供参考。方法：收集我院12576例住院的肺结核患者，采用多学科诊疗模式（MDT），从政策干预、技术支持和人员培训等方面对碳青霉烯类药物的使用进行管理。比较管理前（2016年3月－2017年3月）与管理后（2017年4月－2019年3月）患者平均住院天数、病死率、医院感染率、碳青霉烯类药物使用情况和耐药率；采用中断时间序列分析法（ITS）对管理前后碳青霉烯类药物使用率、用药频度（DDDs）、其DDDs占抗菌药物DDDs比例、其费用占抗菌药物费用比例进行分析；并对碳青霉烯类药物DDDs与医疗质量指标、耐该类药物的细菌检出率等进行Pearson相关性分析。结果：管理后，患者平均住院日、抗菌药物费用以及碳青霉烯类药物DDDs、该类药物费用占抗菌药物费用比例、该类药物DDDs占抗菌药物DDDs比例、该类药物使用率、部分细菌对该类药物的耐药率均较管理前显著下降（P＜0.05）。ITS分析结果显示，管理后碳青霉烯类药物使用率、DDDs、其DDDs占抗菌药物DDDs比例、其费用占抗菌药物费用比例分别下降4.491％、220.276、6.535％、11.747％，差异均有统计学意义（P＜0.05）；与管理前比较，上述指标平均每月分别下降0.330％、17.625、0.308％、0.304％，其中碳青霉烯类药物使用率、DDDs下降趋势显著（P＜0.05）。管理前，肺结核患者铜绿假单胞菌对亚胺培南的耐药率为21.80％，鲍曼不动杆菌对美罗培南、亚胺培南的耐药率均为4.60％；管理后，铜绿假单胞菌对亚胺培南的耐药率为13.00％，鲍曼不动杆菌对美罗培南、亚胺培南的耐药率均为16.30％，管理前后差异均有统计学意义（P＜0.05）。而肠杆菌科细菌的耐药率在管理前后差异无统计学意义（P＞0.05）。Pearson相关性分析显示，碳青霉烯类药物DDDs与患者平均住院日、抗菌药物费用均呈显著正相关（P＜0.05）；亚胺培南DDDs与铜绿假单胞菌耐药率呈显著正相关（P＜0.05）。结论：MDT管理能有效规范肺结核患者的碳青霉烯类药物使用，并可缩短患者的住院时间，降低药物费用、DDDs及部分细菌的耐药率。 |
| ABSTRACT： | OBJECTIVE：To provide reference for the ra tional use of carbap enems in tuberculosis patients. METHODS ：Totally 12 576 tuberculosis inpatients were collected from our hospital. Multi-disciplinary team （MDT） model was adopted for carbapenems management in aspects of policy intervention ，technical support and staff training. Average hospitalization duration ， mortality，nosocomial infective rate ，use and drug resistance of carbapenems were compared before （Mar. 2016-Mar. 2017）and after management （Apr. 2017 to Mar. 2019）. Interrupted time series （ITS）analysis was used to analyze the utilization rate of carbapenems，DDDs，the proportion of carbapenems ’DDDs in the total antibiotics ’DDDs，the proportion of carbapenems ’cost in the total antibiotics ’cost before and after management. Pearson correlation analysis was conducted for DDDs of carbapenems with medical quality indicators and detection rate of carbapenems-resistant bacteria. RESULTS ：After the management ，average hospitalization stay ，the cost of antibiotics ，DDDs of carbapenems ，the proportion of carbapenems ’DDDs in the total antibiotics ’ DDDs，the proportion of carbapenems ’cost in the total antibiotics ’cost，the utilization rate of carbapenems ’，and the drug resistance rate of some bacteria to carbapenems were significantly lower than those before the management （P＜0.05）. ITS analysis results showed that after management ，the utilization rate of carbapenems ，DDDs，the proportion of com carbapenems’DDDs in the total antibiotics ’DDDs and the proportion of carbapenems ’cost in the total antibiotics ’cost hhyyzj@126.com were decrease d by 4.491％ ，220.276，6.535％ ，11.747％ ， with statistical significance （P＜0.05）. Co mpared with before management ，above indexes were decreased by 0.330％，17.625， 0.308％，0.304％ monthly，among which the utilization rate and DDDs of carbapenems were decreased significantly （P＜0.05）. Before management ，drug resistance rate of Pseudomonas aeruginosa to carbapenems was 21.80％，and those of Acinetobacter baumannii to meropenem and imipenem were both 4.60％；after management ，drug resistance rate of P. aeruginosa to imipenem was 13.00％，and those of A. baumannii to meropenem and imipenem were both 16.30％，with statistical significance before and after management （P＜0.05）. There was no statistical significance in drug resistance rate of Enterobacteriaceae （P＞0.05）. Pearson correlation analysis showed that carbapenems ’DDDs was significantly positively correlated with average hospitalization duration and antibiotics ’cost（P＜0.05）；imipenem’s DDDs was positively correlated with drug resistance rate of P. aeruginosa （P＜0.05）. CONCLUSIONS： MDT management can effectively standardize the use of carbapenem in tuberculosis patients ， shorten hospitalization duration ，and reduce drug cost ，DDDs and drug resistance rate of some bacteria. |
| 期刊： | 2021年第32卷第03期 |
| 作者： | 韩晶，史丽霞，谢祎，黄淑萍，张丽霞，张洁 |
| AUTHORS： | HAN Jing，SHI Lixia，XIE Yi，HUANG Shuping ，ZHANG Lixia，ZHANG Jie |
| 关键字： | 多学科诊疗模式；抗菌药物；碳青霉烯类药物；肺结核；中断时间序列分析法；耐药性 |
| KEYWORDS： | Multi-disciplinary team ；Antibiotics；Carbapenems；Tuberculosis；Interrupted time series analysis ；Drug resistance |
| 阅读数： | 360 次 |
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