[墨西哥蒙特雷大都市区6家医院抗生素使用情况评估以及一项旨在改变外科预防用药处方行为的干预措施的影响]
[Assessment of antibiotic use and impact of an intervention intended to modify the prescribing behavior in surgical prophylaxis in 6hospitals in the metropolitan area of Monterrey, Mexico].
作者信息
Palacios-Saucedo Gerardo Del Carmen, de la Garza-Camargo Mauricio, Briones-Lara Evangelina, Carmona-González Sandra, García-Cabello Ricardo, Islas-Esparza Luis Arturo, Saldaña-Flores Gustavo, González-Cano Juan Roberto, González-Ruvalcaba Román, Valadez-Botello Francisco Javier, Muñoz-Maldonado Gerardo Enrique, Montero-Cantú Carlos Alberto, Díaz-Ramos Rita Delia, Solórzano-Santos Fortino
机构信息
Unidad Médica de Alta Especialidad, Hospital de Especialidades N.° 25, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México.
Unidad Médica de Alta Especialidad, Hospital de Especialidades N.° 25, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México.
出版信息
Cir Cir. 2017 Nov-Dec;85(6):459-470. doi: 10.1016/j.circir.2016.10.033. Epub 2017 Jan 4.
BACKGROUND
Improper use of antibiotics increases antimicrobial resistance.
OBJECTIVE
Evaluate the use of antibiotics and the impact of an intervention designed to improve antibiotic prescription for surgical prophylaxis in 6 hospitals of Monterrey, Mexico.
MATERIAL AND METHODS
Design: A prospective multicenter survey and a pretest-postest experimental study. Phase 1: Survey to evaluate the use of antibiotics through an especially designed guide. Phase 2: Intervention designed to improve antibiotic prescription for surgical prophylaxis by the medical staff by using printed, audiovisual and electronic messages. Phase 3: Survey to evaluate the impact of the intervention.
ANALYSIS
Frequencies, percentages, medians, ranges and X test.
RESULTS
Phase 1: We evaluated 358 surgical patients, 274 prophylactic antibiotic regimens. A total of 96% of antibiotics regimens began with inappropriate timing (290/302), 82.8% were inappropriate regimens (274/331), 77.7% were in inappropriate dosage (230/296), 86% of inadequate length (241/280), and in 17.4% restricted antibiotics were used (52/299). Phase 2: 9 sessions including 189 physicians (14 department chairs, 58 general practitioners and 117 residents). Phase 3: We evaluated 303 surgical patients, 218 prophylactic antibiotics regimens. Inappropriate treatment commencement was reduced to 84.1% (180/214) (P<0.001), inappropriate regimens to 75.3% (162/215) (P=0.03), inappropriate dosages to 51.2% (110/215) (P<0.001), and use of restricted antibiotics to 8.3% (18/215) (P=0.003).
CONCLUSIONS
Inappropriate use of prophylactic antibiotics in surgery is a frequent problem in Monterrey. The intervention improved the antibiotic prescription for surgical prophylaxis by reducing inappropriate treatment commencement, regimens, dosages, and overuse of restricted antibiotics. It is necessary to strengthen strategies to improve the prescription of antibiotics in surgical prophylaxis.
背景
抗生素使用不当会增加抗菌药物耐药性。
目的
评估墨西哥蒙特雷6家医院抗生素的使用情况以及一项旨在改善外科手术预防性抗生素处方的干预措施的影响。
材料与方法
设计：一项前瞻性多中心调查和一项前后测实验研究。第1阶段：通过专门设计的指南评估抗生素的使用情况。第2阶段：通过使用印刷、视听和电子信息，设计干预措施以改善医务人员用于外科手术预防的抗生素处方。第3阶段：调查评估干预措施的影响。
分析
频率、百分比、中位数、范围和X检验。
结果
第1阶段：我们评估了358例外科手术患者，274种预防性抗生素治疗方案。共有96%的抗生素治疗方案起始时间不当（290/302），82.8%的治疗方案不合适（274/331），77.7%的剂量不合适（230/296），86%的疗程不足（241/280），17.4%使用了限制级抗生素（52/299）。第2阶段：9次培训课程，包括189名医生（14名科室主任、58名全科医生和117名住院医师）。第3阶段：我们评估了303例外科手术患者，218种预防性抗生素治疗方案。不当治疗起始率降至84.1%（180/214）（P<0.001），不合适的治疗方案降至75.3%（162/215）（P=0.03），不当剂量降至51.2%（110/215）（P<0.001），限制级抗生素的使用降至8.3%（18/215）（P=0.003）。
结论
在蒙特雷，外科手术中预防性抗生素使用不当是一个常见问题。该干预措施通过减少不当治疗起始、治疗方案、剂量以及限制级抗生素的过度使用，改善了外科手术预防性抗生素的处方。有必要加强策略以改善外科手术预防中抗生素的处方。
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