抗菌药物规范管理对胸外科手术患者术后肺部感染的影响

Effects of antimicrobial stewardship on postoperative pulmonary infections in patients undergoing thoracic surgery

关键词:  抗菌药物管理  术后感染  病原微生物

Key words:  antimicrobial management  postoperative infection  pathogenic microorganisms

摘要:

目的评估抗菌药物规范管理对肺部手术患者术后肺部感染的影响，以帮助临床制定更精准的抗菌药物使用方案，降低术后感染率。 方法采用回顾性研究，提取2022年1月—2024年3月同济大学附属上海市肺科医院外科住院患者资料。患者分为3组: 管理前组(2022年1月—2023年6月)、管理中组(2023年7—9月)和管理后组(2023年10月—2024年3月)。通过单病种抗菌药物管理，包括针对特定单病种的抗菌药物使用政策和指南以及严格执行标准化流程等，比较各组患者的抗菌药物使用强度及各种病原菌感染情况。数据分析采用χ2检验、t检验及Logistic回归分析。 结果共纳入40769例患者。管理前组抗菌药物使用强度为148.0±15.7，管理中组为38.6±3.1，管理后组为43.1±6.9，差异有统计学意义(P<0.001)。术后肺部感染发生率在管理前为3.80%，管理中为4.27%，管理后组降至1.66%，差异有统计学意义(P<0.001)。多因素分析显示，男性、年龄＞60岁是术后肺部感染的危险因素，而抗菌药物规范管理是保护因素。 结论抗菌药物规范管理可显著降低肺部手术患者术后感染风险，有效控制多重耐药菌及主要病原微生物的感染发生率，从而遏制细菌耐药性发展，同时提升患者治疗效果与临床安全性。

Abstract:

ObjectiveTo evaluate the impact of standardized antimicrobial stewardship on postoperative pulmonary infections in patients undergoing pulmonary surgery, with the goal of facilitating the development of more precise antimicrobial use protocols and reducing postoperative infection rates. MethodsThe data from surgical inpatients at Shanghai Pulmonary Hospital Affiliated with Tongji University between January 2022 and March 2024 were analyzed retrospectively. Patients were categorized into three groups: pre-intervention group(January 2022 to June 2023), intervention phase group(July to September 2023), and post-intervention group(October 2023 to March 2024). Through disease-specific antimicrobial stewardship, including implementation of targeted antimicrobial use policies, clinical guidelines, and strict adherence to standardized protocols, the antimicrobial use intensity and pathogen infection profiles among the groups were compared. Statistical analyses included χ2 tests, t-tests and Logistic regression analysis. ResultsThe study included 40769 patients. Antimicrobial use intensity was 148.0±15.7 in the pre-intervention group, 38.6±3.1 in the intervention phase group, and 43.1±6.9 in post-intervention group, with statistically significant differences(P<0.001). The postoperative pulmonary infection rates was 3.80% in the pre-intervention group, 4.27% in intervention phase group, and it decreased to 1.66% in post-intervention group (P<0.001). Multivariate analysis indicated that male gender and age >60 years were risk factors for postoperative pulmonary infection, while the standardized antimicrobial stewardship served as a protective factor. ConclusionStandardized antimicrobial stewardship effectively reduces postoperative infection rates in pulmonary surgery patients, controls multidrug-resistant organism and major pathogenic microorganism infections, significantly mitigates bacterial resistance, and improves both treatment efficacy and patient safety.