Effects of the antimicrobial management program in a large university hospital_West China Medical Journal

Authors：

LI Jingwen ¹ , XIE Yi ² , HUANG Wenzhi ¹ , QIAO Fu ¹ , ZHU Shichao ¹ ,  ZONG Zhiyong ^1,3 , CHEN Min ⁴ , GUAN Mei ⁵

1. Infection Prevention & Control Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Center for Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
4. Medical Affairs Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
5. Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

ZONG Zhiyong, Email: 1006852844@qq.com

Keywords：

Antimicrobial agent; Antimicrobial management; Antibiotics use density; Antimicrobial resistance; Average length of hospital stay; Mortality rate

DOI：

10.7507/1002-0179.201901132

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Objective To investigate the effects of antimicrobial management program on inpatients outcomes and antimicrobial resistance among clinical isolates in a large-scaled university hospital.Methods The antibiotics use density (AUD) and antimicrobial resistance rate of multi-drug resistant bacteria before (from January 2009 to December 2010) and after (from January 2012 to December 2016) the intervention of antimicrobial management program in a large-scaled university hospital (4 300 beds) were calculated and compared, and the correlations of AUD with average length of hospital stay and mortality rate were analyzed.Results The AUD was significantly decreased after intervention (P<0.001). The resistance rate of Staphylococcus aureus to oxacillin decreased (P<0.001). Among Gram-negative bacteria, the resistance rates to carbapenems in Acinetobacter baumannii (P<0.001) and Klebsiella pneumoniae increased (P=0.011). AUD was not correlated with the average length of hospital stay (P=0.644), while positively correlated with the in-hospital mortality rate (r=0.932, P=0.001).Conclusions The implementation of antimicrobial management program can significantly reduce the antimicrobial use and do not worsen patient outcomes in the hospital. The impact of the program on resistance varies significantly depending on both the bacterium and the agent, and carbapenem-non-susceptible Gram-negative bacilli emerges as a major threat. It is still necessary to combine other infection control measures.

Citation： LI Jingwen, XIE Yi, HUANG Wenzhi, QIAO Fu, ZHU Shichao, ZONG Zhiyong, CHEN Min, GUAN Mei. Effects of the antimicrobial management program in a large university hospital. West China Medical Journal, 2019, 34(3): 262-266. doi: 10.7507/1002-0179.201901132 Copy

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19.	呂軼娟. 基于衛生經濟學理論的醫院平均住院日影響因素研究. 現代醫院, 2018, 18(5): 658-661.

1. Roehr B. Renewed efforts are needed to curb antibiotic resistance. BMJ, 2012, 345(15): e7778.
2. Hvistendahl M. Public Health. China takes aim at rampant antibiotic resistance. Science, 2012, 336(683): 795.
3. 陳新謙, 金有豫, 湯光. 新編藥物學. 17 版. 北京: 人民衛生出版社, 2001: 34-134.
4. 中華人民共和國國家衛生和計劃生育委員會. 醫院感染管理質量控制指標 (2015 年版). (2015-03-31)[2019-01-01]. http://www.nhfpc.gov.cn/ewebeditor/uploadfile/2015/04/20150415094217171.pdf.
5. Goldmann DA, Weinstein RA, Wenzel RP, et al. Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals. A challenge to hospital leadership. JAMA, 1996, 275(3): 234-240.
6. Elaine. 細菌耐藥再敲警鐘. 中國處方藥, 2010(10): 17.
7. Rogues AM, Dumartin C, Lasheras A, et al. Determinants of glycopeptides consumption in hospitals. Microb Drug Resist, 2007, 13(3): 199-203.
8. Yoshida J, Akagi K, Ishimaru T, et al. Drug resistance of Pseudomonas aeruginosa in four community hospitals: influence of antimicrobial use density. Jpn J Antibiot, 64(4): 247-253.
9. 張國兵, 毛小紅, 吳志強, 等. 肺炎克雷伯菌耐藥與抗菌藥物使用強度的相關性分析. 中華醫院感染學雜志, 2017, 27(11): 2427-2429.
10. 曾曉媛, 楊紅忠, 彭毅強, 等. 2008 年至 2011 年抗菌藥物使用量與鮑曼不動桿菌耐藥性的相關性研究. 中國醫師雜志, 2012, 14(11): 1518-1520.
11. 陳瑋. 某三級綜合醫院細菌耐藥與抗菌藥應用相關性研究. 濟南: 山東大學, 2016.
12. 李耘, 呂媛, 鄭波, 等. 中國細菌耐藥監測研究 2015-2016 革蘭氏陰性菌監測報告. 中國臨床藥理學雜志, 2017, 33(23): 2521-2542.
13. 蔡惠惠, 王萍, 趙水娣. 我院抗菌藥使用與鮑曼不動桿菌耐藥性變化的相關性分析. 中國藥師, 2016, 19(4): 712-714.
14. 周晴, 胡必杰, 黃聲雷, 等. SICU 鮑氏不動桿菌耐藥率與抗菌藥物使用劑量相關性分析. 中華醫院感染學雜志, 2012, 22(19): 4326-4329.
15. 莢恒敏, 張亮. 肺炎克雷伯菌對亞胺培南耐藥性與其使用量的相關性研究. 中國感染控制雜志, 2013, 12(5): 336-338.
16. 陳佰義, 何禮賢, 胡必杰, 等. 中國鮑曼不動桿菌感染診治與防控專家共識. 中國醫藥科學, 2012, 2(8): 3-8.
17. Poumaras S, Poulou A, Tsakris A. Inhibitor-based methods for the detection of KPC carbapenemase-producing Enterobacteriaceae in clinical practice by using boronic acid compounds. J Antimicrob Chemother, 2010, 65(7): 1319-1321.
18. 郭玉琴. 兒科重癥監護病房合理使用抗菌藥物干預效果分析. 廣州: 南方醫科大學, 2016.
19. 呂軼娟. 基于衛生經濟學理論的醫院平均住院日影響因素研究. 現代醫院, 2018, 18(5): 658-661.

West China Medical Journal

Effects of the antimicrobial management program in a large university hospital

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