Analysis On The Preventive Use Of Antibiotics In Perinatal Period In A Hospital

Objective:1.To investigate the use of antibiotics during the delivery period in a hospital of Shanghai in 2017,and to analyze the application status of antibiotics.2.According to the guidelines for clinical application of antimicrobial agents(2015)and the implementation rules for perioperative prophylactic use of antimicrobial agents for cesarean section(2010)and guidelines for diagnosis and management of premature rupture of membranes(2015),the current situation of the use of antimicrobial agents in the obstetric department of the hospital was analyzed to evaluate the rationality of its application.3.According to the application status of antibacterial drugs in intrapartum,specific improvement and optimization measures were put forward to improve the rationality of the use of antibacterial drugs,reduce the generation of drug-resistant bacteria,and reduce the medical expenses.Methods:1.A total of 385 cases were collected from 220,130 and 55 cases randomly selected from the east hospital,the west hospital and the south hospital,respectively.229 cases were selected as subjects(see the fourth part of chapter 1 for details).The medical records of 229 patients were counted,including:admission number,age,diagnosis,common name of antibacterial drugs,total hospital expenses,total hospital drug expenses,total hospital antibacterial drug expenses,usage and dosage,starting and ending time,etc.Regression analysis,statistical description analysis and other methods were used to analyze the overall use of antimicrobial agents in the selected medical records.2.According to the mode of parturient delivery,the status of antibacterial drugs in natural delivery and cesarean section was investigated.3.According to the clinical application of antibacterial drugs guidelines(2015),the cesarean section surgery perioperative prevention with antibacterial drugs management rules(2010)and the diagnosis and treatment guidelines of the premature rupture of membranes(2015),analyzes the natural birth and cesarean delivery,premature rupture of membranes application of antimicrobial agents of three typical cases,and analyzes the process of the preparation plan and evaluate its rationality,and put forward reasonableSuggestions.Results:1.Basic situation of maternity.The average maternal age was 31.41 years.Mean gestational age:38+6.82;The average length of stay was 4.39 days.The rate of cesarean section was 42.79%.The average cost of antibacterial drugs was 73.38yuan.2.Antibacterial drug selection.There were 13 product regulations in 6 categories of antimicrobial drugs for prevention,with cefradine in cephalosporins,cefazolin and cefoxitin in cephalosporins as the main prophylactic drugs.Most of the antibiotics used can get into the placenta and breast milk.3.Drug use rate.The utilization rate of antibacterials was 59.82%,including 100%for cesarean section and 29.77%for natural delivery.The usage rate of puerpera with PROM was 78.26%,which was less than 5 cases of puerpera with PROM below 18h.4.The medication time.64.10%of natural delivery and 80.61%of cesarean delivery not more than 24 h;5.13%of natural delivery and 4.08%of cesarean delivery more than 48 h,2 cases and 4 cases respectively.The medication time of PROM was not more than 48 h.5.Cesarean delivery time.In cesarean section of preventive medicine,98 cases of maternal,88.77%of women use broken umbilical dosing+1 time after surgery for one way(or intraoperative again additional 1 times).Single postoperative medication only 2 cases;The preoperative medication of nine,more for preoperative oral medicine and hospital medicine.6.Per capita use antimicrobial drugs species changes with age.The species per 0.86,under 30 age group with an average of 0.82,more than 35 years old age group with an average of 1.16.7.Drug delivery way,solvent selection and combination of conform to the rules.Injection and oral way;Solvent selection for water for injection or sodium chloride injection;Duplex medication to cefazolin or cephalosporins and indications for coupled,no more than triple medications.8.Three months after the improvement measures were optimized,50 pieces of medical records from November to December 2018 were randomly checked for doctor's advice comment.,The conformance between the application of antimicrobial prophylaxis and the guideline for"the guidelines for clinical application of antimicrobial agents(2015)"was 96.00%.Conclusion:The use of antibiotics in the obstetrics of the hospital in Shanghai is generally more standardized,but there were still some shortcomings,such as inappropriate selection of antibacterial drugs,improper time of medication and long duration of medication.At present,there is still a small gap between the current clinical use of antibiotics during childbirth and " the guidelines for clinical application of antimicrobial agents(2015)".In order to further improve the rational use of antibacterial drugs during the delivery period,it is necessary to further strengthen the implementation of " the guidelines for clinical application of antimicrobial agents(2015)" in obstetrics.On the basis of the current comprehensive antibacterial drug supervision and management,clinical path and AMS construction,through the improvement of information management methods,deepen the clinical pharmacy work,strengthen communication and cooperation with medical staff,so that clinical pharmacists fully integrate into the medical team and participate in clinical drugs.The formulation of the program promotes the rational use of antibacterial drugs,which was conducive to reducing expenses,saving resources and reducing the production of drug-resistant bacteria.