中国一家医院中，药师对接受清洁或清洁-污染手术的泌尿外科住院患者预防性使用抗生素的干预措施。

Pharmacist interventions for prophylactic antibiotic use in urological inpatients undergoing clean or clean-contaminated operations in a Chinese hospital.

作者信息

Zhang Hai-Xia, Li Xin, Huo Hai-Qin, Liang Pei, Zhang Jin-Ping, Ge Wei-Hong

机构信息

Department of Pharmacy, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.

Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China.

出版信息

PLoS One. 2014 Feb 25;9(2):e88971. doi: 10.1371/journal.pone.0088971. eCollection 2014.

DOI:10.1371/journal.pone.0088971

PMID:24586465

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3934870/

Abstract

OBJECTIVES

To evaluate the impact and cost-benefit value of pharmacist interventions for prophylactic antibiotic use in surgical patients undergoing clean or clean-contaminated operations.

METHODS

A pre-to-post intervention study was performed in the Department of Urological Surgery of a tertiary hospital. Patients admitted from January through June 2011, undergoing clean or clean-contaminated surgery, served as the pre-intervention group; patients admitted from January through June 2012 formed the post-intervention group. Pharmacist interventions were performed for the surgeries in the post-intervention group. The criteria for the rational use of antibiotic prophylaxis were established by the hospital administration. The pharmacist interventions included real-time monitoring of medical records and controlling of the prescriptions of prophylactic antibiotics against the criteria. The pre- and post-intervention groups were then compared to evaluate the outcomes of the pharmacist interventions. A cost-benefit analysis was performed to determine the economic effects of implementing the pharmacist intervention on preoperative antibiotic prophylaxis.

RESULTS

After the pharmacist intervention, a significant decrease was found in the rate of no indications for prophylactic antibiotic use (p = 0.004), the rate of broad-spectrum antibiotic use (p<0.001), the rate of drug replacement (p<0.001) and the rate of prolonged duration of prophylaxis (p<0.001). Significant reductions were observed in the mean antibiotic cost (p<0.001), the mean duration of antibiotic prophylaxis (p<0.001) and the mean number of antibiotics used (p<0.001). A significant increase was observed in the rate of correct choice of antibiotics (p<0.001). The ratio of the net mean cost savings for antibiotics to the mean cost of pharmacist time was approximately 18.79:1.

CONCLUSION

Real-time interventions provided by a clinical pharmacist promoted rational use of prophylactic antibiotics, with a significant reduction in antibiotic costs, thus leading to favorable economic outcomes.

摘要

目的

评估药师干预对接受清洁或清洁-污染手术的外科患者预防性使用抗生素的影响及成本效益价值。

方法

在一家三级医院的泌尿外科进行了一项干预前后对照研究。2011年1月至6月入院接受清洁或清洁-污染手术的患者作为干预前组；2012年1月至6月入院的患者为干预后组。对干预后组的手术进行药师干预。医院管理部门制定了预防性使用抗生素的合理标准。药师干预包括实时监测病历，并对照标准控制预防性抗生素的处方。然后比较干预前组和干预后组，以评估药师干预的效果。进行成本效益分析，以确定实施药师干预对术前抗生素预防的经济影响。

结果

药师干预后，预防性抗生素无用药指征率（p = 0.004）、广谱抗生素使用率（p<0.001）、换药率（p<0.001）和预防用药时间延长率（p<0.001）均显著降低。抗生素平均费用（p<0.001）、抗生素预防平均时间（p<0.001）和使用抗生素的平均种类数（p<0.001）均显著减少。抗生素正确选择率显著提高（p<0.001）。抗生素平均净成本节约与药师时间平均成本的比值约为18.79:1。