醫院抗生管制政策.pptVIP

抗藥性菌株比率 2004-2012 台中慈濟醫院抗生素管控政策：源起 台中慈濟醫院為新成立的醫院，醫療人員網羅自四面八方，整合非常困難，抗生素費用接近總藥費的20%，經該院詹總顧問的提示，本人銜命進行管控 由於該院感染科主任無法訂出令人信服的指南，且與資訊室之合作並不順暢，本人接手後決定暫緩症候群管控，改由其他方式進行 本人決定由管控超長使用及合併用藥著手處理 台中慈濟醫院抗生素管控政策：執行辦法 要求醫院資訊室每日回報抗生素使用超過14日或是合併三種藥物的病人 感染科醫師立即探視病人，並與主治醫師討論是否有需要繼續治療？是否可以減少、停藥、或是改成口服？ 所有討論資料一律作成紀錄，每月就違規抗生素使用之醫師做出統計，送請院長及科室主任進行輔導 台中慈濟醫院抗生素管控實例 * 結論 指南管理確實能達到減少抗生素用量及不增加耐藥細菌之雙重目標，但由人去執行不易達到目標，完全或大部分由電腦控制可減少人為的誤差及貪瀆 由管控超長用藥及合併用藥也可不必經由改變電腦程式，但能逼迫醫師診斷對病人及用對藥物，不失為簡便的感控方式 其他單位，例如微生物實驗室、藥劑科的成功配合，方能確保戰果 懇請賜教 * This presentation will address the risk factors for and the prevention of surgical site infections. * Multiple studies conducted over the past two decades have found that inadequate initial antimicrobial therapy is an independent risk factor for mortality in patients with HAP.10-16 In each of these studies, mortality rates were higher for patients given initial inadequate therapy compared with patients given initial adequate therapy. The Consensus III Expert Group noted that other studies in the literature have found improved outcomes, although the trends may not have been significant (p=ns). Alvarez-Lerma et al. (1996) conducted a 12-month prospective study in Spain of patients with intensive care unit- (ICU) acquired pneumonia (1988 to 1989) (n=530). Patients who received initial inadequate therapy had a significantly higher mortality rate compared with those who received initial appropriate therapy (24.7% versus 16.2%, p=0.0385).10 Rello et al. (1997) conducted a 38-month prospective study in Spain of patients with VAP (n=113). Patients who received initial inadequate therapy had a significantly higher attributable mortality rate than those who received initial appropriate therapy (37.0% versus 15.6%, p0.05).11 Kollef et al. (1998) conducted a 12-month prospective study in the U.S. of patients with VAP (n=130). Patients who required a change in their therapy had a significantly higher mortality rate than those who received initial appropriate therapy (60.8%