目的:评价某院采取多项举措干预Ⅰ类切口手术围手术期患者抗菌药物使用的效果,为抗菌药物合理应用提供依据。方法对2005—2012年该院每年4月份和10月份9823例Ⅰ类切口手术患者进行回顾性调查,以2005年的数据为基线,2006—2012年采取培训、考核、监督、反馈及与相关部门合作等多项举措进行干预,比较干预前后抗菌药物使用情况。结果Ⅰ类切口手术围手术期患者抗菌药物使用合格率从2006年的14.20%提高至2012年的92.30%;2006—2009年抗菌药物联合用药率偏高(7.00%~9.00%),2010—2012年呈下降趋势,2012年下降至3.20%。2006和2007年该院Ⅰ类切口手术预防使用抗菌药物种类与2005年(基线)基本相似,主要为头孢菌素类、青霉素及其复合制剂、氨基糖苷类;2008—2012年预防使用的主要抗菌药物是第一、二代头孢菌素,青霉素类及其复合制剂。多因素非条件 logistic 回归分析结果显示,年龄(40~59岁)、科室(骨科、普通外科和眼科)和年份(2011和2012年)是抗菌药物使用合格与否的主要影响因素(均 P <0.05)。结论采取多项举措进行干预可提高Ⅰ类切口手术围手术期抗菌药物使用合格率,减少使用抗菌药物种类,降低联合用药率。%Objective To evaluate the effect of multiple intervention measures on perioperative antimicrobial use in pa-tients undergoing typeⅠincision operation in a hospital,and provide basis for rational use of antimicrobial agents. Methods 9 823 patients with type I incision operation in April and October of 2005-2012 were surveyed retrospectively, data of 2005 was as baseline,from 2006 to 2012,multiple measures,including training,examination,supervision,feed-back,and cooperation of relevant departments were conducted,antimicrobial use before and after intervention was com-pared.Results The qualified rate of perioperative antimicrobial use in patients undergoing typeⅠ incision operation in-creased from 14.20% in 2006 to 92.30% in 2012;the rate of combined use of antimicrobial agents was relatively higher (7.00%-9.00%)in 2006-2009,had a downward trend in 2010- 2012,and decreased to 3.20% in 2012.Types of an-timicrobial agents for prophylactic use in typeⅠincision operation in 2006 and 2007 were similar to that of 2005,the main used antimicrobial agents were cephalosporins,penicillin and it’s compounds,and aminoglycosides;the major antimicrobial prophylaxis in 2008-2012 were the first and second generation cephalosporins,penicillin and it’s compounds.Multivariate non-conditional logistic regression analysis showed that age (40 - 59 years old),departments (orthopedics,general surgery,and ophthalmology),and years (2011 and 2012)were the main influencing factors for the qualified use of antimicrobial agents(all P<0.05).Conclusion Implementation of multiple intervention measures can improve the qualified rate of perioperative antimicrobial use in typeⅠ incision operation,reduce types of antimicrobial use and rate of combined antimicrobial use.
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