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目的研究一体化项目型(IPMT)管理模式对抗菌药物管理有效性。方法选取2011年11月1日-2012年10月31日Ⅰ类切口手术出院16 641例,逐月调查Ⅰ类切口手术围术期抗菌药物使用率、合理率(包括选药、疗程及术前给药时机均合理)以及手术部位感染率,并对同期59 951例住院抗菌药物使用率、使用强度、住院用药比例、治疗性抗菌药物微生物送检率进行调查。结果Ⅰ类切口手术抗菌药物使用率逐月下降,从2011年11月的50.35%下降至2012年10月的24.39%,同时合理率由80.13%上升至92.57%;Ⅰ类切口手术部位感染率0.19%～0.36%;同期住院抗菌药物使用率由57.31%下降至48.07%,抗菌药物使用强度由64.9DDD下降至49.8DDD;住院用药比例由35.44%下降至29.97%;治疗性使用限制类抗菌药物微生物送检率由60.78%提高至64.25%,治疗性使用特殊类抗菌药物微生物送检率由71.88%提高至84.65%;经检验手术部位感染率和治疗性使用限制类抗菌药物微生物送检率,差异无统计学意义,其他调查结果差异均有统计学意义(P<0.01)。结论IPMT管理模式可有效降低Ⅰ类切口手术抗菌药物使用率、提高合理率,同时有效降低住院抗菌药物使用率、使用强度以及用药比例,有效提高治疗性使用特殊类抗菌药物微生物送检率。
Objective To study the effectiveness of integrated project management (IPMT) in the management of antimicrobial agents. Methods From January 1, 2011 to October 31, 2012, 16 641 cases of type Ⅰ incision were discharged. The rate of antibacterials utilization during the perioperative period of type Ⅰ incision was investigated monthly. The reasonable rate (including drug selection, duration of treatment and preoperative The timing of administration was reasonable) and the infection rate of the surgical site. 59,951 inpatients were investigated for the antibacterial drug use rate, the intensity of use, the proportion of hospitalized drugs and the rate of the therapeutic antibacterial drug in the same period. Results The usage of antibacterials in Class I incision decreased month by month from 50.35% in November 2011 to 24.39% in October 2012, and the reasonable rate increased from 80.13% to 92.57%. The infection rate of Class Ⅰ incision surgery site was 0.19 % ~ 0.36%. The rate of inpatient use of antimicrobial drugs decreased from 57.31% to 48.07% and the intensity of antimicrobial use decreased from 64.9DDD to 49.8DDD in the same period. The proportion of inpatients decreased from 35.44% to 29.97% The detection rate increased from 60.78% to 64.25%, the therapeutic rate of special antimicrobial agents was increased from 71.88% to 84.65%, and the rate of infection in the surgical site and the limited use rate of antibiotics in the treatment group were lower No statistical significance, the other survey results were statistically significant (P <0.01). Conclusions IPMT management mode can effectively reduce the usage of antimicrobial agents in type Ⅰ incision and improve the reasonable rate. Meanwhile, it can effectively reduce the rate of inpatient use of antibiotics, the intensity of use and the proportion of medication, and effectively improve the delivery rate of microbiological treatment of special antimicrobial agents.