| Background:Antibacterial drugs have been playing a vital role in controlling the infectious diseases that jeopardize the human health.However,with the wide use of antibacterial drugs,some new problems have arisen,such as toxic reaction,double infection,bacterial drug resistance.Most of all,antimicrobial resistance caused by irrationally using antibacterial drugs has become a worldwide public health problem,which not only threatens human health and life,but also produces massive waste of health resources.The hospitals are the main sites for antibacterial drugs.Focusing on how to improve the rational use of antibacterial drugs in hospitals,a large number of practice and research has been carried out.So far,the hospitals in most developed countries and districts mainly adopt Antimicrobial Stewardship(AMS)strategy for antimicrobial stewardship.In 201 1,China has issued Plans on National Rectification of Clinical Application of Antimicrobial Drugs,implementing some intervening countermeasures and initiating three-years' rectification of antimicrobial drugs administration.Objective:Through researching on the administrative situation of antimicrobial drugs in the tertiary hospitals in Nanjing and the effect of rectification of antimicrobial drugs,comparing with the AMS strategy in foreign countries,this paper intends to research and evaluate the existing problems and shortcomings of antimicrobial stewardship in the tertiary hospitals in Nanjing.Combining with the advanced countermeasures and experience from AMS strategy overseas,this paper provides basis and strategy suggestions of establishing scientific long-term mechanism of antimicrobial stewardship in hospitals so as to present feasible policy proposals on improving scientific level of antimicrobial stewardship in hospitals in Nanjing and reducing bacterial drug resistance.Method:Apply literature research method to summarize current situation of antimicrobial stewardship in hospitals in China and overseas.Apply questionnaire survey and qualitative interview methods to analyze the implementation situation and process of antimicrobial stewardship in the tertiary hospitals in Nanjing.Apply mathematical modeling to extract statistics of antimicrobial drug use in HIS system in three typical tertiary hospitals in Nanjing.Adopt intermittent time series regression model to evaluate short-term and long-term effect of implementation of intervening countermeasures of antimicrobial drugs.Result:After giving out institution questionnaires to 25 tertiary hospitals in Nanjing,I have received 20 valid questionnaires with a valid response rate of 80%.According to the questionnaires,in the professional antimicrobial stewardship teams in 20 tertiary hospitals in Nanjing,the average numbers of clinical microbiology expert,epidemic disease expert,IT staff and nurse are all under one.Ten hospitals lack infectious diseases guide books,accounting for 50%.Ten hospitals implement prescription preliminary verification policy on antimicrobial drugs of special use level,accounting for 50%.All 20 hospitals are implementing 6 kinds of administrative intervention countermeasures to varying extent.All 20 hospitals carry out education and training on clinical application of antimicrobial drugs for physicians and only four hospitals carry out education for patients,accounting for 20%.According to the statistics of antimicrobial drugs application of three typical hospital information systems,after the intervention,there are obvious declines(P<0.001)on usage rate,usage intensity of antimicrobial drugs on inpatients,usage rate of antimicrobial drugs on outpatient and I-type incision infection prevention,while there are obvious increases(P<0.001)on rational selection rate of antimicrobial drugs on I-type incision,dose rate 0.5-2h before the surgery,and the within 24h medication rate on I-type incision.According to the analysis result of intermittent time series,just after the intervention,there are significant declines(P<0.001)on usage rate of antimicrobial drugs on inpatients and the prescription rate of antimicrobial drugs on outpatient.However,the declines transfer to increase trend after the intervention with a bad long-term effect.In two hospitals,there are long-term increase trends(P<0.05)on inpatients' per capita antimicrobial drug expense and the ratio of antimicrobial drug expense in the inpatient expense,reflecting that from the instant and long-term perspectives of implementation,intervention countermeasures have reduced the usage ratio and consumption of antimicrobial drugs,but have never alleviated the financial burden of the patients.Conclusion:Basically,well effect has been received in the antimicrobial stewardship in the tertiary hospitals in Nanjing with well controlling on the irrational use of antimicrobial drugs and improvement on rational drug use.However,compared with the overseas hospitals adopting AMS strategy,the hospitals in China still have own problems and fall behind.Therefore,the hospitals in China should firstly increase manpower and material resources to build multi-disciplinary management teams.Secondly,they should lay emphasis on training of professional talents to enhance the technological level of the teams.Thirdly,they should continue reinforcing administrative intervention and gradually integrate with professional management.Fourthly,they should fulfill the needs of medical staff to enhance the construction of antimicrobial stewardship information system.Fifthly,they should make innovation on form and content of education training to augment the related medical education on the patients.The last but not the least,they should devote greater effort on real-time supervisory control on clinical application of therapeutic antimicrobial drugs. |
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