Yang Zhifu, Zhao Peixi, Wang Jingwen, Tong Liping, Cao Jinyi, Tian Yun, Yao Zhanpeng, Wang Jingbo, Zhu Yanrong, Jia Yanyan, Wen Aidong
Department of Pharmacy, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China.
Department of Pharmacy, Shaanxi Province Tumor Hospital, Xi'an, Shaanxi, People's Republic of China.
PLoS One. 2014 Aug 22;9(8):e102226. doi: 10.1371/journal.pone.0102226. eCollection 2014.
Irrational use of antimicrobial agents for preventing postoperative SSIs is a common phenomenon in China, which results in more bacterial resistance, higher hospital infection rates, extra costs of antimicrobial agents. The aim of the study is to evaluate the effect of Drug Rational Usage Guidelines System (DRUGS) on the surgeon's prescription behavior of antimicrobial agents.
10 common surgical operations which included 1543 cases (where 778 cases using paper-based guidelines and 765 cases using DRUGS) were selected and their demographic and clinical data were collected. The selected operations include thyroid resection, breast mass resection, myomectomy, etc. The evaluation criteria were antibiotic administrative categories, the time of initial dose, duration of administration, length of stay, the costs of antibiotics, SSIs and drug adverse reactions(ADR).
The antimicrobial agents were mostly administrated within 0.5 h to 2 h before incision, 656 patients (85.75%) were intervened with DRUGS and 256 (32.90%) with paper-based guidelines according to the protocol. For the clean wounds incision, 547 patients (91.62%) were within 24 h of withdrawal antibiotics with using paper-based guidelines versus 91 (14.79%) with using DRUGS. A total of 19 kinds of antibiotics were used in the 1543 cases. The leading three on the list of frequency were piperacillin and sulbactam sodium, cefathiamidine and cefoperazone. While after the intervention, the list of frequency changed to cefazolin, cefathiamidine, cefoperazone. The average hospital stay was (7.00±4.31)d with paper-based guidelines and (2.54±1.57)d with DRUGS, respectively. The average cost of antibiotics was ¥(3481.36±2584.46) with paper-based guidelines and ¥(1693.39±1478.27) with DRUGS, respectively. However, there were no significant differences in the incidence of SSIs and ADR between two groups.
In this study, the increased availability of antibiotic guidelines at the time of drug ordering, combined with DRUGS, was associated with an enhanced surgeon adherence to guidelines.
在中国，不合理使用抗菌药物预防术后手术部位感染（SSIs）是一种常见现象，这会导致更多的细菌耐药性、更高的医院感染率以及抗菌药物的额外费用。本研究的目的是评估合理用药指南系统（DRUGS）对外科医生抗菌药物处方行为的影响。
选取10种常见外科手术，共1543例患者（其中778例使用纸质指南，765例使用DRUGS），收集其人口统计学和临床数据。所选手术包括甲状腺切除术、乳腺肿块切除术、子宫肌瘤切除术等。评估标准包括抗生素管理类别、首次给药时间、给药持续时间、住院时间、抗生素费用、手术部位感染和药物不良反应（ADR）。
抗菌药物大多在切口前0.5小时至2小时内给药，按照方案，656例患者（85.75%）接受了DRUGS干预，256例患者（32.90%）接受了纸质指南干预。对于清洁伤口切口，使用纸质指南的547例患者（91.62%）在停药24小时内，而使用DRUGS的为91例（14.79%）。1543例患者共使用了19种抗生素。使用频率排名前三的是哌拉西林舒巴坦钠、头孢硫脒和头孢哌酮。干预后，使用频率排名变为头孢唑林、头孢硫脒、头孢哌酮。使用纸质指南的患者平均住院时间为（7.00±4.31）天，使用DRUGS的为（2.54±1.57）天。使用纸质指南的抗生素平均费用为（3481.36±2584.46）元，使用DRUGS的为（1693.39±1478.27）元。然而，两组手术部位感染和药物不良反应的发生率没有显著差异。
在本研究中，在开医嘱时增加抗生素指南的可得性，并结合DRUGS，与外科医生对指南的依从性提高有关。
