专项整治对综合医院抗菌药物使用强度的影响

??????? 目的 探讨抗菌药物临床应用专项整治活动对综合医院住院患者抗菌药物使用强度的影响。方法 以限定日剂量（DDD）为单位,对某综合性医院在实施专项整治前、后住院患者抗菌药物使用强度（AUD）进行统计、分析。结果 专项整治活动降低了住院患者累计AUD值,大环内酯类等药物AUD明显下降,第二代、第三代和第四代头孢菌素和不同管理级别抗菌药物AUD均下降。但还存在用药集中、注射用头孢哌酮钠舒巴坦钠AUD下降不明显等问题。结论 专项整治有效降低了综合医院住院患者AUD,但与卫生行政部门标准仍存在差距,应进一步加强管理。     

我院专项治理前后抗菌药物使用情况分析

目的:通过分析抗菌药物临床应用专项治理前后住院患者抗菌药的使用情况,以促进合理用药。方法:随机抽取我院2010年1至2011年12月病例1680份,抽取甲状腺/乳腺/疝气/闭合性骨折I类切口手术病历100份,分析治理前后抗菌药物使用率、使用强度、病原送检率、DDDs、DUI及I类切口抗菌药物应用情况。结果:治理前住院患者抗菌药物使用率、使用强度分别为68.50%、49.8DDD;治理后分别为56.2%、37.8DDD,显著降低(P<0.05)。治理前有四种抗菌药物DUI>1,依次为头孢哌酮/舒巴坦钠>头孢噻吩钠=头孢唑啉>头孢呋辛;治理后有两种抗菌药物DUI>1,依次为磺苄西林>头孢哌酮/舒巴坦钠;治理后I类切口手术患者预防使用抗菌药物比例略为下降,疗程符合率、用药合理率明显上升(P<0.05)。结论:我院住院患者抗菌药使用情况基本达到《抗菌药物临床应用专项工作方案》要求。但在某些方面,如I类切口使用率、疗程、用药选择上需要持续改进,应加强对I类切口的监管力度,以确保用药的经济、有效、合理。     

我国抗菌药物临床应用专项整治情况调查与分析

目的 了解抗菌药物临床应用专项整治以来,我国医院的抗菌药物使用情况。方法 2011年和2012年分别选取了241所医院进行调查。运用系统随机抽样方法抽取5—9月期间医院的门诊处方和住院病历进行分析。抗菌药物使用强度（每百人天DDDs值）、门诊患者抗菌药物处方比例、综合I类切口手术预防使用抗菌药物比例等为主要分析指标。结果 从2011年至2012年,被调查医院的平均抗菌药物使用强度和综合I类切口手术预防使用抗菌药物比例下降有统计学意义;门诊患者抗菌药物处方使用率整体变化不显著,联合用药情况仍普遍存在。且医院的规模与抗菌药物使用存在显著关联性。结论 仍需通过进一步加强抗生素耐药性监测以及对医务工作者和公众抗菌药物使用培训等管理措施,从本质上改善抗菌药物使用情况。     

规范医院抗菌药物临床应用的效果与探索??????? ——以某高校7所附属医院为例

某医学院校从2011年5月起在7所直属医院开展抗菌药物临床应用专项整治工作。通过对药品品种、微生物送检、抗菌药物使用情况等指标的分析,评价工作的效果,并从抗菌药物分级管理、围手术期抗菌药物应用和临床药师的作用等角度谈了体会和建议。     

2014年抗菌药物住院处方点评回顾性分析

目的:统计我院住院患者抗菌药物的使用情况,分析不合理用药的表现及原因,促进我院抗菌药物的合理使用,为加强药品的安全监测、指导临床合理用药提供参考。方法:随机抽取我院2014年住院处方1699份,对其中抗菌药物的使用情况进行统计,分析不合理用药现象,研究处方点评干预前后不合理用药的变化。结果:全年共点评1260份清洁手术病例,其中使用抗菌药物病例303份,包括不合理用药病例287份,不合理用药率为94.71%;主要存在的问题为用药时间长、无指征用药及预防用药品种选择不合理。Ⅰ类切口病例中含不合理病例271份,不合理率为28.11%,其中无适应症用药情况最为明显,无适应症用药比例为7.39%。限制级抗菌药物头孢哌酮舒巴坦及特殊级抗菌药物万古霉素不合理应用严重。通过定期专项点评抗菌药物处方并积极落实整改措施,以上不合理应用现象均有明显好转。结论:我院抗菌药物的使用情况不合理使用情况有改善,但仍存在抗菌药物使用不合理情况,需加大力度宣传抗菌药物的合理应用,以确保患者用药安全、有效合理。     

医院等级评审对围手术期预防应用抗菌药物影响评价

目的 为规范医院围手术期抗菌药物预防性应用、探索合理干预措施管理提供依据。方法 通过医院感染监测系统,调取2013年3月、5月医院外科手术病历728例作为非干预组;调取2013年10月、2014年1月全院外科手术病例742例作为干预组。通过各项指标分析比较干预前后围手术期预防性使用抗菌药物情况。结果 开展围手术期抗菌药物临床应用专项整治活动后,Ⅰ类切口手术抗菌药物使用率由100%降至31.66%,围手术期抗菌药物使用率由100%降至59.03%,且术后切口部位感染并未出现增长。术前0.5～2h用药率由整治前的81.59%升高至100%（P ＜0.05)。专项整治后围手术期预防应用抗菌药物时长由5.72天降至1.56天。整治后围术期抗菌药物合理应用明显提高。结论 医院开展围手术期抗菌药物预防应用专项整治取得明显成效。     

采用综合干预措施 加强抗菌药物使用管理

目的 通过采取综合干预措施,促进住院患者抗菌药物的临床合理应用。方法 采用抗菌药物合理使用国际指标进行基线调查后,进行多手段干预,用SPSS12.0软件进行统计分析调查结果,评价干预措施的有效性和可行性。结果 接受抗菌药物治疗的住院患者使用抗菌药物的平均品种数从干预前的2.06种降到干预后的1.78种,抗菌药物治疗的平均费用从干预前的1 038.26元降到干预后的696.21元,抗菌药物的平均使用天数从干预前的6.99 天下降到干预后的5.81天,接受抗菌药物治疗患者的平均住院日从干预前的13天下降到干预后的10天,其他多项指标均有改善。结论 综合干预措施对提高合理用药水平效果显著,促进了管理水平的提升。     

我院门诊抗菌药物处方分析

目的:通过对我院两年半门诊处方随机抽查,了解门诊抗菌药物使用的合理性.方法:抽查2007年1月至2009年6月门诊处方,对处方中使用的抗菌药物类别、用法用量、给药途径、联合用药的合理性进行分析.结果:4152张处方中1162张处方使用了抗菌药物,1032张处方合理,占88.81%.结论:药师对抗菌药物的不合理处方进行干预,我院抗菌药物使用基本合理.     

Cross-Sectional Study on Antibiotic Usage in Pigs in Germany

To be able to analyze the relationship between the level of resistance and the use of antimicrobials, it is necessary to collect detailed data on antimicrobial usage. For this reason, data on antimicrobial use on 495 pig farms from entire Germany were collected and analyzed. In Germany, each application and dispensing of medicines to food-producing animals is documented in detail obligatorily by the veterinarian. This information was collected retrospectively for the year 2011. The analyses undertook separate examinations on the age groups sow, piglet, weaner and fattening pig; both the route of administration and indication per active ingredient, and active ingredient class, were evaluated. In total, 20,374 kg of antimicrobial substances were used in the study population. Tetracyclines were used in highest amounts, followed by beta-lactams, trimethoprim-sulfonamides and macrolides. Concerning the frequency of using an active substance per animal, polypeptides were most commonly administered. In all age groups, respiratory infections were the main indication for using antimicrobials, followed by intestinal diseases in piglets, weaners and fattening pigs and diseases of reproductive organs in sows. Over a period of 100 days, the median number of treatment days with one antimicrobial substance for piglets was 15 days, for weaners about 6 days, for fattening pigs about 4 days and for sows about 1 day. A multifactorial ANOVA was conducted to investigate which factors are associated with the treatment frequency. The factors “veterinarian” and “age group” were related to the treatment frequency, just as the interaction between “veterinarian” and “farm size” as well as the interaction between “veterinarian” and “age group”.     

Antibiotic Use in a Small Community Hospital

Audits of medical records were done for similar one-month periods in 1974 and 1977 in a 125-bed community hospital in Hawaii to determine patterns of antibiotic use. One quarter of all hospital patients in both study periods received antibiotics. In 1977 cephalosporins, ampicillin and aminoglycosides were the most commonly used antibiotics. Half of the antibiotics used by surgical specialty departments in both periods were for prophylactic indications. The cost of antimicrobial prophylaxis per patient was reduced by about 57 percent in 1977 compared with 1974. In the 1977 period, 58 percent of patients received proper prophylactic antibiotic regimens; this was statistically higher than the 15 percent of patients given appropriate prophylactic antibiotics in 1974. Fewer than half of the patients in both study periods treated for infections received correct antibiotic therapy. In contrast, 82 percent of infectious disease consultations were considered appropriate by an independent specialist in infectious disease. However, these consultations were obtained in only 15 percent of the patients who received therapeutic antibiotics. It was concluded that audits of patients receiving antibiotics can be effective in the development of appropriate prophylactic surgical regimens. However, during the study period in 1977, we were not able to show large scale improvement in therapeutic antimicrobial use at this community hospital, either by our attempts at physician education or by making infectious disease consultations available.     

医院员工援助计划机制和作用研究

员工关爱计划作为医院管理层和员工的共同需求,应该成为当前我国医院管理的一项创新举措。通过对医院员工援助计划相关探索的梳理及新近一些研究实践,探讨医院员工援助计划的机制和作用,包括实施必要性、模式选择、特点内容,为医院管理改革创新提供借鉴。

     

Antibiotic Resistance Determinants in a Pseudomonas putida Strain Isolated from a Hospital

Environmental microbes harbor an enormous pool of antibiotic and biocide resistance genes that can impact the resistance profiles of animal and human pathogens via horizontal gene transfer. Pseudomonas putida strains are ubiquitous in soil and water but have been seldom isolated from humans. We have established a collection of P. putida strains isolated from in-patients in different hospitals in France. One of the isolated strains (HB3267) kills insects and is resistant to the majority of the antibiotics used in laboratories and hospitals, including aminoglycosides, ß-lactams, cationic peptides, chromoprotein enediyne antibiotics, dihydrofolate reductase inhibitors, fluoroquinolones and quinolones, glycopeptide antibiotics, macrolides, polyketides and sulfonamides. Similar to other P. putida clinical isolates the strain was sensitive to amikacin. To shed light on the broad pattern of antibiotic resistance, which is rarely found in clinical isolates of this species, the genome of this strain was sequenced and analysed. The study revealed that the determinants of multiple resistance are both chromosomally-borne as well as located on the pPC9 plasmid. Further analysis indicated that pPC9 has recruited antibiotic and biocide resistance genes from environmental microorganisms as well as from opportunistic and true human pathogens. The pPC9 plasmid is not self-transmissible, but can be mobilized by other bacterial plasmids making it capable of spreading antibiotic resistant determinants to new hosts.     

某三级综合医院专病门诊诊疗工作分析

目的 了解某三级综合医院专病门诊的诊疗工作现状,分析专病门诊患者需求及管理模式的特点。方法 对2008—2011年某三级综合医院专病门诊量进行描述性分析、线性回归分析及相关性分析。结果 加强专病门诊管理有利于提高医疗质量和水平,简化门诊流程,实施疾病全程式规范化管理与治疗,提高门诊医疗服务效率。结论 近年来专病门诊已逐渐成为门诊工作的增长点,为适应学科发展及患者需求,需不断规范对专病门诊的管理与建设。     

人本管理在医院人力资源管理中的运用

以人本管理理念和马斯洛需求层次论为理论基础,分析了当前医院人力资源管理存在的人本理念缺失、人本向成本妥协,人力资源战略意识欠缺、绩效考核低效欠公正、人才管理缺乏特色、人才激励缺乏凝聚力和向心力等问题,提出以医院员工生存需求和安全需求的满足为人力资源管理的基石,使社交需求和归属需求的满足成为人心凝聚的催化剂,使发展需求和自我实现需求成为人力资源发展规划的方向,利用现代化的信息网络技术建设高效、公正的绩效考核体系,加强医院文化内涵建设满足员工多元化需求的医院人力资源人本管理解决思路。     

Evaluation of a HIV Voluntary Opt-Out Screening Program in a Singapore Hospital

Background

Early diagnosis of human immunodeficiency virus (HIV) allows for appropriately timed interventions with improved outcomes, but HIV screening among asymptomatic persons and the general population in Singapore remains low. In 2008, Singapore’s Ministry of Health implemented HIV voluntary opt-out screening (VOS) for hospitalised adults. We evaluated the outcome of VOS and surveyed reasons for its low uptake in our institution.

Methods

We assessed the outcomes of the VOS programme from January 2010 to December 2013 at National University Hospital, a 1081-bed tertiary hospital in Singapore. We also examined reasons for opting-in and opting-out using an interviewer–administered structured questionnaire in a representative sample in January 2013.

Results

107,523 patients fulfilled VOS criteria and were offered HIV screening, of which 5215 (4.9%) agreed to testing. 4850 (93.1%) of those who opted-in had an HIV test done. Three (0.06%) tested positive for HIV. 238 patients (14.2%) were surveyed regarding reasons for opting-in or out of VOS. 21 (8.8%) had opted-in. Patients who opted-in were likely to be younger, more educated and reported having more regular sexual partners. Type of housing, number of casual sexual partners, sexual orientation, intravenous drug use, condom use and previous sexually transmitted infection were not associated with deciding to opt-in/out. Patients’ most common reasons for opting-out were: belief that they were at low risk (50.2%), belief that they were too old (26.8%), cost (6.9%) and aversion to venepuncture (6.5%). The most common reason for opting-in was desire to know their HIV status (47.6%).

Conclusion

The success of an HIV-VOS program is largely determined by test uptake. Our study showed that the majority of eligible VOS patients opted-out of HIV screening. Given the considerable cost and low yield of this programme, more needs to be done to better equip patients in self-risk assessment and opting in to testing.