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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2. Hvistendahl M. Public Health. China takes aim at rampant antibiotic resistance. Science, 2012, 336(683): 795.
3. 陈新谦, 金有豫, 汤光. 新编药物学. 17 版. 北京: 人民卫生出版社, 2001: 34-134.
4. 中华人民共和国国家卫生和计划生育委员会. 医院感染管理质量控制指标 (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. 细菌耐药再敲警钟. 中国处方药, 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. 张国兵, 毛小红, 吴志强, 等. 肺炎克雷伯菌耐药与抗菌药物使用强度的相关性分析. 中华医院感染学杂志, 2017, 27(11): 2427-2429.
10. 曾晓媛, 杨红忠, 彭毅强, 等. 2008 年至 2011 年抗菌药物使用量与鲍曼不动杆菌耐药性的相关性研究. 中国医师杂志, 2012, 14(11): 1518-1520.
11. 陈玮. 某三级综合医院细菌耐药与抗菌药应用相关性研究. 济南: 山东大学, 2016.
12. 李耘, 吕媛, 郑波, 等. 中国细菌耐药监测研究 2015-2016 革兰氏阴性菌监测报告. 中国临床药理学杂志, 2017, 33(23): 2521-2542.
13. 蔡惠惠, 王萍, 赵水娣. 我院抗菌药使用与鲍曼不动杆菌耐药性变化的相关性分析. 中国药师, 2016, 19(4): 712-714.
14. 周晴, 胡必杰, 黄声雷, 等. SICU 鲍氏不动杆菌耐药率与抗菌药物使用剂量相关性分析. 中华医院感染学杂志, 2012, 22(19): 4326-4329.
15. 荚恒敏, 张亮. 肺炎克雷伯菌对亚胺培南耐药性与其使用量的相关性研究. 中国感染控制杂志, 2013, 12(5): 336-338.
16. 陈佰义, 何礼贤, 胡必杰, 等. 中国鲍曼不动杆菌感染诊治与防控专家共识. 中国医药科学, 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. 儿科重症监护病房合理使用抗菌药物干预效果分析. 广州: 南方医科大学, 2016.
19. 吕轶娟. 基于卫生经济学理论的医院平均住院日影响因素研究. 现代医院, 2018, 18(5): 658-661.

West China Medical Journal

Effects of the antimicrobial management program in a large university hospital

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