论文部分内容阅读
本研究旨在评估中国三级医院抗菌药物管理(AMS)的发展情况,以发现管理过程中存在的挑战并为相关政策的制定提供参考与基准.本研究是一项面向全国细菌耐药监测网(CARSS)入网三级医院的横断面问卷调查.调查问卷包括5个部分,分别是AMS组织建设情况、技术支撑体系建立情况、抗菌药物临床应用管理情况、抗菌药物临床应用监督工作情况和AMS培训宣传情况.2018年,所有入网CARSS的1044家三级医院中,有140(13.4％)家医院参加了本研究.样本医院中,139(99.3％)家医院建立了AMS;115(82.1％)家医院的AMS结果负责人是医院院长,83(59.3％)家医院的AMS结果负责科室是医务部门;139(99.3％)家医院采用了抗菌药物分级管理;感染性疾病科、感染控制部门和微生物检验科分别己在122(87.1％)、139(99.3％)和140(100％)家医院设立;临床路径和医院个体化感染性疾病指南分别在124(85.6％)家和47(33.6％)家医院开展实施;139(99.3％)家、138(98.6％)家和134(95.7％)家医院分别开展了门诊处方审核、住院处方审核和预防性使用抗菌药物处方审核的工作;136(97.1％)家医院参加了全国抗菌药物临床应用监测网;139(99.3％)家医院建立了碳青霉烯和替加环素专档管理;140(100％)家和126(90.0％)家医院分别以不同的方式和频率对医务人员和公众开展科普教育.中国三级医院的AMS主要由医院院长领导,涉及多个学科和行政部门之间的合作.相关部门应进一步促进和加强个体化指南的制定并建立过程与结果并重的评价体系.“,”In the present study,we aimed to assess the development of the antimicrobial stewardship (AMS) program in China\'s tertiary hospitals to identify the potential challenges for the AMS program and provide references and benchmarks for strategic policymaking.A nationwide cross-sectional study was conducted online by sending questionnaires to tertiary hospitals under China Antimicrobial Resistance Surveillance System (CARSS).The questionnaire included 5 sections regarding structure,technical support,antimicrobial use management,antimicrobial use surveillance,and education.Descriptive statistics were used for data analysis.Of the 1044 tertiary hospitals under CARSS,13.4％ (140) hospitals participated in the study.Among them,99.3％ (139/140) set up the AMS program.The hospital president (82.1％,115/140) and medical service department (59.3％,83/140) were responsible for AMS outcomes in most hospitals.Structured antimicrobial formulary restriction management was adopted by 99.3％ (139/140) hospitals.Infectious disease department,infection control department,and microbiological laboratories were established in 87.1％ (122/140),99.3％ (139/140) and 100％ (140/140) hospitals,respectively.Up to 85.6％ (124/140)hospitals applied clinical pathways,and 33.6％ (47/140) hospitals implemented hospital-specific guidelines for infectious diseases.Outpatient prescription auditing,inpatient prescription auditing,and prophylactic antimicrobial prescription auditing of aseptic operation were performed in 99.3％ (139/140),98.6％ (138/140) and 95.7％ (134/140) hospitals,respectively.Up to 97.1％ (136/140)hospitals participated in antimicrobial use surveillance network,and 99.3 ％ (139/140) hospitals established the specialized management of carbapenem and tigecycline.Staff education and public education were provided with various ways and frequencies in 100％ (140/140) and 90.0％ (126/140) hospitals,respectively.AMS programs in China\'s tertiary hospitals were primarily headed by hospital presidents and involved collaboration among various disciplines and administrative departments.More efforts should be put to further promote and strengthen the development of hospital-specific guidelines and the establishment of a progress and outcome evaluation system.