背景:真菌感染的急剧增加,真菌感染的诊断和治疗能力不足,真菌感染患者预后差以及真菌耐药性的增加是严重的临床问题。有必要探讨抗真菌药物管理(AFS)的实施和评价方法,以促进抗真菌药物的规范使用。
方法:AFS计划在中国的三级甲等医院使用计划-执行-检查-行为(PDCA)质量管理工具实施。进行基线调查,以确定试点医院抗真菌药物的使用情况,分析存在的问题和原因,并提出相应的解决方案。AFS计划于2021年开始提出并实施,包括各个方面,比如团队建设,建立法规,信息化建设,处方审查和专业培训。从多个角度记录了管理有效性,例如抗真菌药物的消费,临床标本的微生物检查率,以及合理处方的比例。运用PDCA管理理念进行持续改进,实现闭环管理。
结果:在实施AFS计划后的第一年,消费成本,抗真菌药物的使用强度和使用率显著下降(P<0.01)。抗真菌药物合理处方比例明显增加,有适应症的处方比例从2019年的86.4%增加到2022年的97.0%,用法和剂量适当的处方比例从51.9%增加到87.1%。此外,在AFS计划实施后,医生对完成微生物检查的必要性的认识提高,真菌培养和血清学检查的数量大幅增加。药物敏感性试验的统计数据显示,念珠菌对氟康唑的耐药率降低。
结论:本研究表明,AFS联合PDCA循环可有效减少抗真菌药物用量,促进抗真菌药物的合理使用。为其他医疗保健系统减少抗真菌药物的过度使用和延缓真菌耐药性的进展提供参考。
BACKGROUND: The sharp increase in fungal infections, insufficient diagnostic and treatment capabilities for fungal infections, poor prognosis of patients with fungal infections as well as the increasing drug resistance of fungi are serious clinical problems. It is necessary to explore the implementation and evaluation methods of antifungal stewardship (AFS) to promote the standardized use of antifungal drugs.
METHODS: The AFS programme was implemented at a tertiary first-class hospital in
China using a plan-do-check-act (PDCA) quality management tool. A baseline investigation was carried out to determine the utilization of antifungal drugs in pilot hospitals, analyse the existing problems and causes, and propose corresponding solutions. The AFS programme was proposed and implemented beginning in 2021, and included various aspects, such as team building, establishment of regulations, information construction, prescription review and professional training. The management effectiveness was recorded from multiple perspectives, such as the consumption of antifungal drugs, the microbial inspection rate of clinical specimens, and the proportion of rational prescriptions. The PDCA management concept was used for continuous improvement to achieve closed-loop management.
RESULTS: In the first year after the implementation of the AFS programme, the consumption cost, use intensity and utilization rate of antifungal drugs decreased significantly (P < 0.01). The proportion of rational antifungal drug prescriptions markedly increased, with the proportion of prescriptions with indications increasing from 86.4% in 2019 to 97.0% in 2022, and the proportion of prescriptions with appropriate usage and dosage increased from 51.9 to 87.1%. In addition, after the implementation of the AFS programme, physicians\' awareness of the need to complete microbial examinations improved, and the number of fungal cultures and serological examinations increased substantially. Statistics from drug susceptibility tests revealed a decrease in the resistance rate of Candida to fluconazole.
CONCLUSIONS: This study indicated that the combination of AFS and the PDCA cycle could effectively reduce antifungal consumption and promote the rational use of antifungal drugs, providing a reference for other health care systems to reduce the overuse of antifungal drugs and delay the progression of fungal resistance.