上海市92所医院抗菌药物使用与耐药菌检出调查

Survey on antibacterial drug use and detection of drug-resistant bacteria in 92 hospitals in Shanghai

    摘要
  • 摘要:
    目的 调查上海市92所二级及以上医院抗菌药物使用及主要MDROs检出情况, 比较二级与三级医院的差异, 探索抗菌药物使用与MDROs检出关联, 为精准化防控提供依据。
    方法 采用网络填报的形式, 于2023年2月对上海市92所医院2022年1月1日-12月31日患者抗菌药物使用及耐药菌的检出进行回顾性调查, 数据采用SPSS 23.0统计软件进行分析。
    结果 共纳入92所医院, 其中二级医院50所, 三级医院42所, 二级医院的抗菌药物使用率高于三级医院(46.06% vs. 38.86%, χ2=10 855.056, P＜0.001)。二级医院的MRSA (52.97% vs. 45.29%)、VRE (0.68% vs. 0.09%)和耐碳青霉烯大肠埃希菌(3.29% vs. 2.84%)检出率均高于三级医院(P＜0.05), 三级医院的CRAB、CRKB高于二级医院(P＜0.05)。抗菌药物使用增加, VRE的检出率增加(P＜0.05)。
    结论 医院级别差异影响耐药谱特征, 加强抗菌药物的合理应用是控制MDROs的关键, 应针对不同级别医院特点, 制定和实施精准的抗菌药物管理及感染防控措施。

     

    Abstract:
    OBJECTIVE To investigate the antibacterial drug use and the detection of major MDROs in 92 secondary and higher-level hospitals in Shanghai, compare their differences between secondary and tertiary hospitals, explore the correlation between the antibacterial drug usage and the detection of MDROs, so as to provide a basis for precise prevention and control.
    METHODS A retrospective survey was conducted in Feb. 2023 through online reporting forms, covering the antibacterial drug use and the detection of drug-resistant bacteria in patients from 92 hospitals in Shanghai from Jan. 1 to Dec. 31, 2022. Data were analyzed with SPSS 23.0 statistical software.
    RESULTS A total of 92 hospitals were included, including 50 secondary hospitals and 42 tertiary hospitals. The usage rate of antibacterial drugs in secondary hospitals was higher than that in tertiary hospitals (46.06% vs. 38.86%, χ2=10 855.056, P < 0.001). The detection rates of MRSA (52.97% vs. 45.29%), VRE (0.68% vs. 0.09%) and carbapenem-resistant Escherichia coli (3.29% vs. 2.84%) were all higher in secondary hospitals than in tertiary hospitals (P < 0.05). Conversely, CRAB and CRKP were more prevalent in tertiary hospitals than in secondary hospitals (P < 0.05). The increase in antibacterial drug use was associated with an elevated detection rate of VRE (P < 0.05).
    CONCLUSIONS Differences in hospital levels affect drug resistance spectrum characteristics. Strengthening the rational use of antibacterial drugs is key to control MDROs. Precise antibacterial drug management and infection prevention and control measures should be developed and implemented in accordance with the characteristics of hospitals of different levels.

     

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