中国临床药学杂志

目的 探索医疗机构临床药师有效参与抗菌药物管控的模式，以提升抗菌药物合理使用水平。方法 通过组建药学管控团队，开展“1+2”药学服务，抗菌药物处方点评闭环管理及抗菌药物持续监控、反馈及整改等措施，构建临床药师主导的抗菌药物精细化管理模式。通过医院信息系统收集管控前（2021年）及管控后（2022-2024年）抗菌药物使用、医院感染及细菌耐药相关数据，比较管控前后住院患者抗菌药物使用率、抗菌药物使用强度、人均抗菌药物消耗量、人均抗菌药物费用、医院感染发生率、手术部位感染发生率、外科围术期预防使用抗菌药物合理率、内科系统抗菌药物联合用药比例及碳青霉烯耐药肠杆菌检出率。结果 从2021年至2024年，抗菌药物使用强度持续降低，由51.31 DDDs降至38.32 DDDs；人均抗菌药物费用持续降低，由701.70元降至267.31元；外科围术期预防使用抗菌药物合理率持续提高，由75.12%上升至96.79%；内科系统抗菌药物联合用药比例持续降低，由37.33%下降至30.76%；住院患者医院感染发生率持续降低，由0.75%下降至0.39%；碳青霉烯耐药肠杆菌总检出率持续降低，由9.0%降至5.2%；手术部位感染发生率差异无统计学意义（P > 0.05）。结论 临床药师主导的抗菌药物精细化管理模式，改善了医师抗菌药物处方行为，降低了抗菌药物使用强度，提高了抗菌药物合理使用水平。

AIM To provide a reference for clinical pharmacists in medical institutions to effectively participate in the control of antibacterial agents and improve the rational use of antibacterial agents. METHODS A refined, clinical pharmacist-led management system for antibacterial agents was developed through the establishment of a medication management team, providing a "1+2" pharmaceutical care model, closed-loop management of antibacterial prescription review, along with continuous monitoring, feedback, and systematic improvements in antibacterial usage. Pre-control(2021) and post-control(2022-2024) data on antibacterial use, hospital perception and bacterial drug resistance were collected through the hospital information system. The utilization rate of antibacterial agents, the intensity of antibacterial use, the consumption of antibacterial agents per capita, the cost of antibacterial agents per capita, the incidence of hospital infection, the incidence of surgical site infection, the rational rate of antibacterial prophylaxis during the perioperative period, the proportion of combined use of antibacterial agents in internal medicine, and the detection rate of carbapenem-resistant Enterobacter(CRE) were compared before and after control. RESULTS From 2021 to 2024, the intensity of antibacterial use continued to decrease, from 51.31 DDDs to 38.32 DDDs. The per capita cost of antibacterial agents continuously decreased from 701.70 yuan to 267.31 yuan. The rational rate of antibacterial prophylaxis during the perioperative period increased from 75.12% to 96.71%. The proportion of combined use of antibacterial agents in the internal medicine system decreased from 37.33% to 30.76%. The incidence of nosocomial infection in hospitalized patients decreased from 0.75% to 0.39%. The total detection rate of CRE continued to decrease from 9.0% to 5.2%. There was no significant difference in the incidence of surgical site infection(P > 0.05). CONCLUSION The refined management model of antibacterial agents led by clinical pharmacists has improved the prescribing behavior of physicians for antibacterial agents, reduced the intensity of antibacterial use, and enhanced the level of rational use of antibacterial agents.