Management Effect Analysis Of Clinical Application Of Antibacterial Drug In One Hospital

As the abuse of antibiotics and bacterial resistance is increasingly serious.In order to make the clinical use of antibacterial drugs reasonable and safe, China has successively promulgated the technical guidance documents such as "Guidelines for clinical use of antibacterials", No.48document and No38document, however, with a little success.To change the present use of antibacterial drugs completely,China has developed a three-year renovation of antibacterials since2011,what’s more, every year has new guidelines.China promulgated the "Regulations of clinical application of antibacterial drug" in2012, it indicates the determination of the government to govern the abuse of the antibacterial drugs.It makes the act of using antibiotics become a legal instrument,and makes it into a serious and sacred state.In response to the requirements of The Ministry of Health, a hospital spent three years to renovate the use of the antibiotics. Achievements can reflect from the index of the use of antibiotics and the sensitivity of bacteria to drugs.Part1The change of each index before and after a three-year renovation of antibacterialsPurpose:To analysis the achievements from the change of each index before and after the antimicrobial activities of antibacterials in the hospital.Method:Derive the inpatient usage of antibacterial drugs,the inpatient intensity of use antibacterial drugs,he proportion of outpatient antimicrobial prescription,the rate of antibiotic prophylaxis of type1incision.the effective rate of surgical operation in0.5h to2h,the effective rate of type1incision operation,from January,2010to December,2013from the information center of a hospital.Use the EXCEL to calculate and sort the date.Use the SPSS13.0to analyze the date.Before the renovation,the number of samples n1=18, after the renovation,the number of samples n2=30,the percentage is not often follow the Gaussian Distribution,use the median and interquartile range to describe.Use the W method to check up.Result:Before the renovation the use of antibacterial drugs of inpatient is91.33%(September,2010),91.61%(October,2010),after the renovation the usage is steady decline.lt declines to50.22%in November2013,49.62%in December2013. Before the renovation the usage of antibacterial drugs in hospital arrives118.9(November2010),114.8(December2010),after the innovation,the number steadily declines, November2013is35, December2013is29.31. Before the renovation the proportion of outpatient Antimicrobial prescription is18.94%(May2011)、18.15%(June,2011),After the innovation the percentage is steady decline, September,2013is4.47%, December,2013is5.15%.Especially the rate of Antibiotic prophylaxis of type1incision,before the innovation the rate is100%(before June2011),after the innovation the rate steadily declines,it declines to34.11%in November2013,31.87%in December2013.Both the effective rate of surgical operation in0.5h to2h and the Antibiotic prophylaxis of type1incision achieved remarkable results,which is0.00%before the innovation,after the innovation the former one arrives99.62%(September,2013),99.64%(December,2013), the later one arrives83.39%(October2013),80.33%(December2013),The index had statistical significance before and after the innovation by the W method test.Part2The change of the sensitive rate of several common clinical bacteria to antibacterials before and after a three-year renovation of antibacterials.Purpose:Analysis the change of the sensitive rate of several common clinical bacteria to drugs,before and after the antibiotics innovation,to measure the achievements in the innovation of the hospital. Method:The drug sensitive rate of escherichia coli,klebsiella pneumoniae, aerobacter cloacae,pseudomonas aeruginosa, baumanii,staphylococcus aureus,enterococcus faecalis,enterococcus faecium from2010to2013is provided by the microbiology laboratory.Use the EXCEL to analyze the data.Result:From2010to2013pathogenic strains are3125strain,4261strain,4375strain,3164strain. Then changes of the sensitive rate of several common clinical bacteria to drugs are as follows.1.The sensitive rate of escherichia coli to meropenem and imipenem≥97.9%, both are the choice drug of escherichia coli.The sensitive rate of escherichia coli to amikacin is84.4%,88.9%,91.0%,92.4%(2010-2013).In the next place is piperacillin/tazobactam, the rate is83.3%,76.6%,78.1%,90.5%(2010-2013).The rate of cefoperazone/sulbactam is83.4%,68.2%,62.8%,79.7%(2010-2013).Both of the two can be used to treat the infection. The lowest sensitive rate is cefazolin9.2%(2013),the next is cefuroxime and ciprofloxacin, sensitive rate are34.6%,33.0%(2013). From2011to2013,the sensitive rate of escherichia coli to drugs is overall picking up.2.The sensitive rate of klebsiella pneumoniae to meropenem, imipenem>97.6%,it can be the choice drug of klebsiella pneumoniae.In the next place is amikacin, its rate is91.3%,93.4%,92.0%,96.8%(2010-2013). The next is piperacillin/tazobactam,the sensitive rate is from73.5%(2010)rise up to91.4%(2013).The sensitive rate to cefoperazone, sulbactam, cefepime, ceftazidime, aztreonam, levofloxacin≥80.8%(2013).The lowest sensitive rate of cefazolin is63.3%and cefuroxime is65.7%.From2010to2013,the sensitive rate of klebsiella pneumoniae to drugs is overall picking up.3.The sensitive rate of aerobacter cloacae to meropenem, imipenem≥92.9%.It keeps a better antibacterial activity to amikacin and cefepime,and the sensitive rate is increasing to different degrees for levofloxacin and ciprofloxacin.The sensitive rate of cefoperazone/sulbactam,piperacillin/tazobactam are growing from2011to2013. The sensitive rate to other drugs is growing, but still insensitive.4. The sensitive rate of pseudomonas aeruginosa to amikacin is the highest≥90.0%. The sensitive rate of ceftazidime is78.7%,82.0%,89.0%,83.4%(2010-2013).The sensitive rate to piperacillin/tazobactam is66.8%,73.0%,88.1%,83.9%(2010-2013). The sensitive rate to imipenem is64.6%.70.9%,79.1%.83.4%(2010-2013).The sensitive rate to meropenem is67.5%,70.2%,82.1%,83.2%(2010-2013).The sensitive rate to ciprofloxacin is68.6%,71.9%,82.7%,83.4%(2010-2013).All the date show a rising trend year by year from2010to2012, some drugs show a rising trend to compare2012and2013.5. The sensitive rate of baumanii to cefoperazone/sulbactam is69.1%,and it’s also the highest rate. We can learn from the data that the sensitive rate of baumanii to drugs decreased year by year,from2010to2012, however,the rebound in2013is evident.The sensitive rate of meropenem is rising up from30.0%(2012)to36.0%(2013).The sensitive rate of imipenem is rising up from31.4%(2012)to35.0%(2013).But baumanii is insensitive to all drugs.6.The sensitive rate of staphylococcus aureus to teicoplanin, vancomycin≥99.2%(2010-2013).The sensitive rate to rifampicin is above93.3%.The sensitive rate to cefazolin is78.0%,84.2%,90.5%,89.9%(2010-2013).The sensitive rate to levofloxacin is78.7%,73.7%,76.6%,89%(2010-2013).The sensitive rate to oxacillin is63.6%,76.6%,86.6%,85.2%, and all shows a rising trend.7. The sensitive rate of enterococcus faecalis to linezolid is100%.The sensitive rate to vancomycin,teicoplanin>93.8%.The sensitive rate to penicillin,ampicillin, gentamicin decreased from2010to2012. But it shows a rising trend to compare2012and2013.8. The sensitive rate of enterococcus faecium to teicoplanin, linezolid is100%.The sensitive rate to vancomycin is above94.9%. It also sensitive to chloramphenicol,the sensitive rate is83.1%,75.8%,78.6%,69.4%,from2010to2013,but it shows a decreasing trend year by year.The sensitive rate to other drugs shows a rising trend compared with2013and2012.Conclusions:1.By the innovation of antibacterials, every index is improved compared with the past, especially the rate of antibiotic prophylaxis of type1incision,the effective rate of surgical operation in0.5h to2h, the effective rate of type1incision operation are improved greatly.2.From the perspective of bacterial resistance sensitivity,the innovation of antibacterials is effective. The sensitive rate is rising gradually after the innovation of antibacterials, the clinical medication usage level is gradually increasing,clinical drug selection pressure is decreasing.3.The innovation of antibacterials in the hospital is highly effective.