某社區醫院抗生素管理組合式系統介入對細菌抗藥性的影響

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某社區醫院抗生素管理組合式系統介入對細菌抗藥性的影響

Impact on antibiotic resistance after modified antibiotic stewardship bundle in a community hospital

廖嘉宏 , Masters　　Advisor：魏正宗　　

繁體中文

管制性抗生素；抗生素管理；多重抗藥性細菌；抗生素敏感性； Restricted antibiotic ； antibiotic stewardship program ； multiple-drug resistant bacteria ； antibiotic susceptibility

Abstract │ Reference (61) │ Altmetrics

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Abstract
Objective : 
Antibiotic stewardship programs in hospitals are important for restricted resource protection and against multiple-drug resistant bacteria. We analyzed the impaction before and after the interventions of modified antibiotic stewardship bundles in a community hospital.
Methods and Materials : 
We continuously observed the impaction of antibiotics stewardship bundle interventions in a community hospital since January 1, 2012 to December 31, 2014. The antibiotic stewardship bundle interventions were performed since January 1, 2013. The bundles included construction of a team work, institution specific guidelines, education, and an antibiotic preauthorization system. We calculated the antibiotic consumptions and costs of all categories, average inpatient duration, all-cause mortality and antibiotic susceptibility of bacteria.
Results : 
The results showed that significantly decreased restricted antibiotic consumptions and total antibiotic cost ( 10.1%, p=0.009 ). Antibiotic susceptibility of bacteria also improved significantly, including  Escherichia coli to Amikacin (74.8%  92.0%, p<0.001); Ceftriaxone (55.9% 67.2%, p=0.039), Piperacillin/tazobactam (60.0% 67.2%, p=0.017), Ciprofloxacin (49.7% 65.5%, p<0.001), Amikacin (76.8%  90.8%, p<0.001); Acinetobacter baumannii to Ciprofloxacin (5.3%  16.0%, p<0.001) and Imipenem/cilastatin (16.3% 36.2%, p<0.001). About staphylococcus aureus, susceptibility to Oxacillin (29%  37%, p=0.013) and Gentamicin(40.6%  66.8%, p<0.001) also increased significantly. 
Conclusion : 
Institution specific antibiotic stewardship bundle interventions may resulted in decreased consumption of broad spectrum antibiotics, decreased cost of total antibiotics, and improved antibiotic susceptibility of bacteria between preintervention period and postintervention period.

Key words: 
Restricted antibiotic; antibiotic stewardship program; multiple-drug resistant bacteria; antibiotic susceptibility.

Reference ( 61 ) 〈TOP〉

1. Dellit T.H., Owens R.C., McGowan J.E. Jr., Gerding D.N., Weinstein R.A., Burke J.P., Huskins W.C., Paterson D.L., Fishman N.O., Carpenter C.F., Brennan P.J., Billeter M., Hooton T.M. 2007. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin. Infect. Dis. : 44:159-177.
連結：
3. World Health Organization. 2014. Antimicrobial resistance: global report on surveillance. http://www.who.int/drugresistance/ documents/surveillancereport/en/ ; Accessed 2014
連結：
4. 許哲翰、李怡慶、黃仁杰、蔡哲福、林佳慧、饒梅馨、簡瓊如。2011年。建構中部地區醫院抗生素合理使用。澄清醫護管理雜誌：第七卷第三期：6-21。
連結：
5. Jarvis W.R. 1996. Preventing the emergence of multidrug-resistant microorganisms through antimicrobial use controls: the complexity of the problem. Infect. Control Hosp. Epidemiol.: 17(8): 490-495.
連結：
6. 胡杏宜、顏永豐、徐育芝。2013年。探討抗生素管理計畫對醫療機構與照護品質之影響。感控雜誌：第二十三卷第三期：144-148。
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