中国卫生部的抗菌药物管理措施减少了重症患者的多重耐药菌分离株：一项来自单一中心的前后对照研究。
Antimicrobial stewardship of Chinese ministry of health reduces multidrug-resistant organism isolates in critically ill patients: a pre-post study from a single center.
作者信息
Ma Xudong, Xie Jianfeng, Yang Yi, Guo Fengmei, Gao Zhiwei, Shao Hua, Huang Yingzi, Yang Congshan, Qiu Haibo
机构信息
School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430074, China.
Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China.
出版信息
BMC Infect Dis. 2016 Nov 25;16(1):704. doi: 10.1186/s12879-016-2051-8.
BACKGROUND
China's Ministry of Health (MOH) has established a policy about the antimicrobial stewardship. To date, the effects of this policy on multidrug-resistant organism (MDRO) in critically ill patients are unknown.
METHODS
A pre-post study was conducted on intensive care unit (ICU) patients from June 2010 to May 2011 and from June 2012 to May 2013. Bacterial cultures were conducted at ICU admission and discharge. In June 2011, our hospital started to administer the antimicrobial stewardship program of Chinese MOH. We collected the data on antimicrobial consumption during the 3-year period in all hospital and individual department every month, and analyzed the correlation between the proportion of critically patients colonized or infected with MDRO and antimicrobial consumption.
RESULTS
A total of 978 patients were involved in the present study. With the intervention, the monthly mean Defined Daily Dose (DDD) per 100 occupied bed-days throughout the hospital decreased from 96 ± 7 to 65 ± 6 (p < 0.001), and the proportion of patients colonized or infected with MDRO decreased from 36 to 13% at the time of ICU admission and declined from 48 to 29% at the time of ICU discharge (both p < 0.001). There was a significant positive relationship between the proportion of all critically ill patients colonized or infected with MDRO at ICU admission and the DDD of the entire hospital (R = 0.7858, p < 0.001).
CONCLUSION
The antimicrobial stewardship program of Chinese MOH reduced the consumption of antibiotics. Moreover, the proportion of patients colonized or infected with MDRO decreased along with reduced consumption of antibiotics.
TRIAL REGISTRATION
Retrospectively registered: NCT02128399; Date of registration: 22 APR 2014; Detail information web link: https://clinicaltrials.gov/ct2/show/NCT02128399?term=NCT02128399&rank=1.
背景
中国卫生部已制定了一项关于抗菌药物管理的政策。迄今为止，该政策对重症患者中多重耐药菌（MDRO）的影响尚不清楚。
方法
对2010年6月至2011年5月以及2012年6月至2013年5月期间重症监护病房（ICU）的患者进行了一项前后对照研究。在患者入住ICU和出院时进行细菌培养。2011年6月，我院开始实施中国卫生部的抗菌药物管理计划。我们每月收集全院及各科室3年期间的抗菌药物使用数据，并分析MDRO定植或感染的重症患者比例与抗菌药物使用之间的相关性。
结果
本研究共纳入978例患者。通过干预，全院每100占用床日的月平均限定日剂量（DDD）从96±7降至65±6（p<0.001），入住ICU时MDRO定植或感染的患者比例从36%降至13%，出院时从48%降至29%（均p<0.001）。入住ICU时所有MDRO定植或感染的重症患者比例与全院DDD之间存在显著正相关（R=0.7858，p<0.001）。
结论
中国卫生部的抗菌药物管理计划降低了抗生素的使用。此外，随着抗生素使用量的减少，MDRO定植或感染的患者比例也有所下降。
试验注册
回顾性注册；NCT02128399；注册日期：2014年4月22日；详细信息网页链接：https://clinicaltrials.gov/ct2/show/NCT02128399?term=NCT02128399&rank=1 。
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