Rational antibiotic use in China: lessons learnt through introducing surgeons to Australian guidelines.
Rational antibiotic use in China: lessons learnt through introducing surgeons to Australian guidelines.
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DOI：
10.1186/1743-8462-3-5
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发表时间：
2006-05-30
期刊：
影响因子：
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通讯作者：
Harvey, Ken
中科院分区：
文献类型：
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作者：
Zhang, Yan;Harvey, Ken
背景：世界范围内对抗生素耐药性增加的关注已经将注意力集中在改善抗生素使用的策略上。本研究将澳大利亚关于外科手术中预防性使用抗生素的最佳实践指南改编为北京一家教学医院，然后将其作为质量评估和改进工具，并辅以教育干预。方法：在中国专家的帮助下，融合澳大利亚和国际指南材料。然后，将60名连续接受清洁或清洁污染手术的患者（总共120名）为手术预防开出的抗生素与指南建议分三个阶段进行比较;干预前期为2002年6月至8月，干预期为2002年6月至8月，干预期为2003年6月至8月，干预后期为2003年9月至11月。在干预阶段，每两周与大约25名处方医生讨论关于不符合指南雅阁的反馈。此外，还与13名初级外科医生和8名高级知情人一起探讨了影响抗生素使用的当地因素。结果：虽然就抗生素手术预防的原则达成了一致，但在细节上尚未达成共识。在研究的所有阶段，180名接受清洁手术的患者中，78%的患者接受了抗生素预防，而180名接受清洁污染手术的患者中有98%接受了抗生素预防。第二代和第三代头孢菌素类抗生素在低风险清洁和清洁污染操作中占主导地位。几乎所有患者的预防时机都是正确的。96%接受清洁手术的患者的预防持续时间少于24小时，而接受清洁-污染手术的患者仅为62%。干预没有改善预防的持续时间，也没有过度使用和不适当地选择不必要的广谱和昂贵的药物。采访和焦点小组发现，后一个问题的一个重要解释是中国政府的政策，预计医院支持自己主要通过销售的drugs.CONCLUSION：提高抗生素的使用在中国将需要医院的资金改革，更权威的最佳实践指南，医院当局拥抱质量改进。
BACKGROUND: World-wide concern about increasing antibiotic resistance has focused attention on strategies to improve antibiotic use. This research adapted Australian best-practice guidelines on the prophylactic use of antibiotics in surgery to a Beijing teaching hospital and then used them as a quality assessment and improvement tool, supplemented by educational interventions. Qualitative data about factors influencing antibiotic use was also obtained.METHODS: Australian and international guideline materials were amalgamated with the help of Chinese experts. Antibiotics prescribed for surgical prophylaxis in 60 consecutive patients undergoing clean or clean-contaminated surgery (120 total) were then compared with guideline recommendations in three phases; a pre-intervention period from June to August, 2002, an intervention period from June to August 2003 and post-intervention period from September to November 2003. During the intervention phase, feedback about prescriptions not in accord with the guideline was discussed with around 25 prescribers every two weeks. In addition, local factors influencing antibiotic use were explored with 13 junior surgeons and 8 high level informants.RESULTS: While agreement was reached on the principles of antibiotic surgical prophylaxis there was no consensus on detail. Of 180 patients undergoing clean surgery throughout all phases of the study, antibiotic prophylaxis was administered to 78% compared to 98% of the 180 patients undergoing clean-contaminated surgery. Second and third generation cephalosporin antibiotics predominated in both low-risk clean and clean-contaminated operations. The timing of prophylaxis was correct in virtually all patients. The duration of prophylaxis was less than 24 hours in 96% of patients undergoing clean surgery compared to only 62% of patients undergoing clean-contaminated surgery. The intervention produced no improvement in the duration of prophylaxis nor the overuse and inappropriate choice of unnecessary broad-spectrum and expensive drugs. Interviews and focus groups revealed that an important explanation for the latter problem was Chinese government policy which expected hospitals to support themselves largely through the sale of drugs.CONCLUSION: Improving antibiotic use in China will require hospital funding reform, more authoritative best-practice guidelines, and hospital authorities embracing quality improvement.