上海市细菌耐药、抗菌药物应用和医院感染监测报告(2018年度)
上海市细菌耐药、抗菌药物应用和医院感染监测报告(2018年度)
细菌耐药防控多学科协作,起步上海,影响全国
内容简介本书详尽记述了2018年上海市细菌真菌耐药监测网、上海市抗菌药物临床应用监测网以及上...
细菌耐药防控多学科协作,起步上海,影响全国
本书详尽记述了2018年上海市细菌真菌耐药监测网、上海市抗菌药物临床应用监测网以及上海市医院感染防控与监测网（简称“三网”）的监测研究成果。内容包括细菌耐药监测、抗菌药物临床应用监测、医院感染监测与防控，并介绍“三网联动”综合评分标准等。2017年5月，为整合上海市抗菌药物临床应用管理的相关资源，提高抗菌药物临床应用科学化专业化的管理水平，上海市成立了由感染诊疗临床学科、药学专业与管理、微生物、感控、行政管理等多部门多学科专家构成抗菌药物临床应用与管理专家委员会，通过建立“三网联动”机制，促进多部门、多学科协同合作，加强各监测网信息互通联动，进一步推动上海市抗菌药物应用管理和细菌耐药防控工作。本书内容翔实、可靠，反映上海*的细菌耐药、抗菌药物应用等情况，可供相关临床、科研人员参考。
衣承东 1963年12月生，山东省人。研究生学历，博士学位，主治医师、大学讲师职称。现任上海市卫计委副主任；王明贵 1964年11月生，1995年毕业于上海医科大学获医学博士学位，2001年至2003年美国哈佛医学院博士后。1995年以来一直在复旦大学附属华山医院工作，现任复旦大学附属华山医院抗生素研究所所长。
与近年趋势 / 32
（一） 资料与方法 / 32
（二） 结果 / 33
二、 2018年上海市二级医院抗菌药物临床使用数据与近年趋势 / 48
（一） 资料与方法 / 48
（二） 结果 / 49
三、 2018年上海市社区医院抗菌药物临床使用数据与近年趋势 / 63
（一） 资料与方法 / 63
（二） 结果 / 63
（三） 讨论 / 73
四、 2018年上海市抗菌药物临床应用监测结论/ 74
第三篇 医院感染监测与防控报告 / 77
一、 医院感染相关特色监测工作 / 79
2004年，原卫生部等部委颁发《抗菌药物临床应用指导原则》（卫医发〔2004〕285号），揭开了我国抗菌药物临床合理应用及管理的序幕。十余年来，我国在抗菌药物管理（AMS）方面做了大量工作，成效显著，也开展了各类学术活动，AMS领域的理论水平得到极大提高。当前需要进一步思考的问题是：如何将AMS理论转化为实践？如何从卫生行政干预主导的管理转变为专业化、科学化、常态化的管理？
为此，2017年成立“上海市卫生计生委抗菌药物临床应用与管理专家委员会”（以下简称“专委会”，专委会于2019年6月更名为上海市卫生健康委员会抗菌药物临床应用与管理专家委员会），旨在充分发挥上海市细菌感染诊疗相关临床科室、临床微生物、临床药学、医院感染防控、行政管理等多部门、多学科专家的优势，提高抗菌药物临床应用水平，加强医疗机构抗菌药物临床应用管理，保障医疗质量和医疗安全。
专委会成立后，在上海开创性地开展“三网联动”，将上海市细菌真菌耐药监测网、上海市抗菌药物临床应用监测网及上海市医院感染防控与监测网的数据加以整合，加强多学科人员的交流与合作，以提高监测数据的分析与利用水平，积极防控耐药菌感染。专委会成立两年多来，通过“三网联动”做了一系列的探索性工作，循序渐进地开展抗菌药物合理用药及管理，将AMS的政策落地，受到多方关注。在此做扼要回顾：
2017年及2018年，专委会编撰了“上海市细菌耐药、抗菌药物应用和医院感染监测报告”，将“三网”的监测数据整合在一起，形成“三网年鉴”，在业界形成良好反馈。在前两年的基础上，此次于2019年上半年出版2018年度“三网年鉴”，以提高监测数据展现的及时性。
在出版“三网年鉴”的基础上，2018年起，上述3个监测网联合召开年度总结会，报告监测数据，使参会人员对3个监测网的数据有一个全面的了解，同时加强了多学科专业人员的沟通。
经专委会的多轮讨论，2018年建立了4个权重指数的评分标准：“三网联动”复合指标、细菌耐药权重指数、抗菌药物使用权重指数与医院感染权重指数，以期客观评价各医疗机构的相关指标，并作适当的横向比较，此评分标准已刊登于2018年底出版的《上海市细菌耐药、抗菌药物应用和医院感染监测报告（2017年度）》中，评分标准的更新版刊登于本书中。据此4个评分标准获得的结果，2019年上半年，专委会组织多学科专家到10家医疗机构进行了实地督导，每个小组由5名多学科成员组成，每家医疗机构督导半天。根据监测网的数据，找出主要问题，多学科专家实地考察后提出针对性的具可行性的整改、提升方案。督导的出发点是根据监测数据反映的问题，利用多学科的力量真心实意地协助被督导单位提升AMS水平，因而也受到被督导单位领导及专家的欢迎。在初步尝试后，计划于2019年下半年对更多的单位进行实地督导。
本监测报告对上海市2018年“三网”的监测结果进行全面总结、分析。上海市细菌真菌耐药监测网对所有被监测的分离菌的耐药状况做了总结报告，数据来自参与该网监测的上海市三级医院及二级医院。上海市抗菌药物临床应用监测网监测的医疗机构分三级医院、二级医院及社区医疗机构，该网对抗菌药物临床应用状况进行汇总、分析，并分别描绘了近5年各级被监测医疗机构抗菌药物临床应用的变化趋势。上海市医院感染防控与监测网总结报告的内容包括医院感染相关特色监测工作（锐器伤直报数据统计分析、引流瓶管理现状、血培养送检率调查）及医院感染常规监测（ICU目标性监测、围术期抗菌药物预防用药监测、血培养送检率调查、手卫生依从性及用品耗量监测、医院感染现患率调查）等。
希望广大读者特别是全国其他省、自治区与直辖市相关专业人员，不吝提出宝贵意见、建议，共同提高。我们坚信在多学科专家的共同努力下，我国的抗菌药物合理应用水平一定会得到提高，细菌耐药一定能得到遏制！
上海市卫生健康委员会抗菌药物临床应用与管理专家委员会
2019年6月
Shipping Overview:
• Shipping: Standard Domestic Shipping within the United States charges USD 4.99. Standard International Shipping from United Kingdom, Germany and Japan to the United States charges 14.99.
• Order Processing: Please allow 1-2 business days for order processing and preparation before shipment.
• Domestic Shipping: Orders within the U.S. are shipped via USPS or FedEx, depending on the origin of the product. The average transit time is 3-7 business days.
• International Shipping: Currently, we only ship within the USA.
• Tracking Information: Every order is trackable. You will receive a tracking number once your order has been shipped. Products may be shipped from various global fulfillment centers.
Shipping Delays:
Please note that shipping times may vary due to factors beyond our control, such as weather conditions, natural disasters, or peak holiday periods. While we strive to ensure timely delivery, the exact arrival time cannot be guaranteed and is managed by the shipping carrier.
Shipping Options:
-
Standard Delivery: Most orders are shipped within 3-7 business days. Larger items may utilize LTL shipping for safe handling.
-
Handling Time: We handle shipments on business days (Monday - Friday), with a preparation time of 1-2 days.
-
Additional Charges: Some items require additional shipping charges due to their size, weight, or special handling. These charges are specified on the product pages and are not eligible for shipping discounts.
-
Exclusions: Gift cards, packaging, taxes, and prior purchases do not count toward the minimum purchase requirement for free shipping. This offer is valid only for shipments to U.S. addresses, including Puerto Rico.
Delivery Details:
-
Estimates: Standard shipping within the US typically takes 3-7 business days. These are estimates and not guarantees.
-
Shipping Restrictions: We ship to all 50 states, Washington, DC, U.S. territories, and APO/FPO/DPO addresses. Shipping options vary based on the delivery address.
-
Remote Areas: Shipments to remote areas may incur additional charges or require pickup from a nearby shipping partner’s location.
Shipping Confirmation:
You will receive a shipping confirmation email with a tracking number as soon as your order is dispatched. If you do not receive this email immediately, please be assured that your items will arrive within the estimated delivery window provided at checkout.
Order Modifications:
If you need to cancel or modify your order, please contact our customer support immediately.
Issues with Delivery:
If your order shows as delivered but you have not received it, please contact the shipping carrier directly to resolve the issue. For persistent problems, contact our customer service at cs@everymarket.com.
Customer Support:
Our team is available 24/7 to assist you with any questions or concerns regarding your order. We are committed to ensuring a smooth shopping experience.
Return & Refund Policy Overview
Please review our return and refund policies below to ensure a smooth transaction process.
Return Policy
-
Duration: You have 30 days from receiving your item to initiate a return.
-
Condition: Items must be unworn, unwashed, with original tags and packaging intact.
-
Shipping Costs: Customers are responsible for return shipping costs.
-
Packaging: Ensure returned items are well-packaged to avoid damage during transit.
-
Tracking: Use a trackable and insured shipping method as we are not liable for items lost or damaged on return.
-
Initiating a Return: Contact us at cs@everymarket.com to start your return. We will provide a return shipping label and instructions upon approval. Returns without prior approval will not be accepted.
How to Return
-
Method: Returns must be sent back by mail to the address provided in the return instructions.
Return Label
-
Defective Products: Return labels are provided for defective items.
-
Non-Defective Returns: Customers are responsible for obtaining their return shipping label.
Product Conditions for Return
-
Eligible Products: Returns are only accepted for items in new condition.
Nonreturnable Items
Certain items are not eligible for return:
-
Electronic devices after 30 days (e.g., computers, laptops, Kindles)
-
Gift cards, prepaid game cards
-
Perishable goods, live insects, some jewelry, some health and personal care items
-
Customized or personalized products
-
Items with special shipping restrictions
Refund Policy
-
Window: Eligible products may be returned within 30 days of delivery for a refund.
-
Refund Method: Refunds are processed to the original payment method or as store credit for items purchased with gift cards.
-
Processing Time: Refunds are processed within 3-5 business days after we receive the return; please allow additional time for shipping and bank processing.
Claims
Inspect your order upon arrival and report any defects, damages, or incorrect items immediately to allow us to address the issue. For claims, contact our support team with details of the issue.
Exchange Policy
For the quickest service, return your original item and place a new order for the desired product once your return is accepted.
Return Address
EveryMarket Customer Service 2101 E Terra Ln, O'Fallon, MO 63366
Customer Support
Available 24/7 for any questions or assistance needed:
-
Phone: +1 636-312-5925
-
Email: cs@everymarket.com
细菌耐药防控多学科协作,起步上海,影响全国
本书详尽记述了2018年上海市细菌真菌耐药监测网、上海市抗菌药物临床应用监测网以及上海市医院感染防控与监测网（简称“三网”）的监测研究成果。内容包括细菌耐药监测、抗菌药物临床应用监测、医院感染监测与防控，并介绍“三网联动”综合评分标准等。2017年5月，为整合上海市抗菌药物临床应用管理的相关资源，提高抗菌药物临床应用科学化专业化的管理水平，上海市成立了由感染诊疗临床学科、药学专业与管理、微生物、感控、行政管理等多部门多学科专家构成抗菌药物临床应用与管理专家委员会，通过建立“三网联动”机制，促进多部门、多学科协同合作，加强各监测网信息互通联动，进一步推动上海市抗菌药物应用管理和细菌耐药防控工作。本书内容翔实、可靠，反映上海*的细菌耐药、抗菌药物应用等情况，可供相关临床、科研人员参考。
衣承东 1963年12月生，山东省人。研究生学历，博士学位，主治医师、大学讲师职称。现任上海市卫计委副主任；王明贵 1964年11月生，1995年毕业于上海医科大学获医学博士学位，2001年至2003年美国哈佛医学院博士后。1995年以来一直在复旦大学附属华山医院工作，现任复旦大学附属华山医院抗生素研究所所长。
与近年趋势 / 32
（一） 资料与方法 / 32
（二） 结果 / 33
二、 2018年上海市二级医院抗菌药物临床使用数据与近年趋势 / 48
（一） 资料与方法 / 48
（二） 结果 / 49
三、 2018年上海市社区医院抗菌药物临床使用数据与近年趋势 / 63
（一） 资料与方法 / 63
（二） 结果 / 63
（三） 讨论 / 73
四、 2018年上海市抗菌药物临床应用监测结论/ 74
第三篇 医院感染监测与防控报告 / 77
一、 医院感染相关特色监测工作 / 79
2004年，原卫生部等部委颁发《抗菌药物临床应用指导原则》（卫医发〔2004〕285号），揭开了我国抗菌药物临床合理应用及管理的序幕。十余年来，我国在抗菌药物管理（AMS）方面做了大量工作，成效显著，也开展了各类学术活动，AMS领域的理论水平得到极大提高。当前需要进一步思考的问题是：如何将AMS理论转化为实践？如何从卫生行政干预主导的管理转变为专业化、科学化、常态化的管理？
为此，2017年成立“上海市卫生计生委抗菌药物临床应用与管理专家委员会”（以下简称“专委会”，专委会于2019年6月更名为上海市卫生健康委员会抗菌药物临床应用与管理专家委员会），旨在充分发挥上海市细菌感染诊疗相关临床科室、临床微生物、临床药学、医院感染防控、行政管理等多部门、多学科专家的优势，提高抗菌药物临床应用水平，加强医疗机构抗菌药物临床应用管理，保障医疗质量和医疗安全。
专委会成立后，在上海开创性地开展“三网联动”，将上海市细菌真菌耐药监测网、上海市抗菌药物临床应用监测网及上海市医院感染防控与监测网的数据加以整合，加强多学科人员的交流与合作，以提高监测数据的分析与利用水平，积极防控耐药菌感染。专委会成立两年多来，通过“三网联动”做了一系列的探索性工作，循序渐进地开展抗菌药物合理用药及管理，将AMS的政策落地，受到多方关注。在此做扼要回顾：
2017年及2018年，专委会编撰了“上海市细菌耐药、抗菌药物应用和医院感染监测报告”，将“三网”的监测数据整合在一起，形成“三网年鉴”，在业界形成良好反馈。在前两年的基础上，此次于2019年上半年出版2018年度“三网年鉴”，以提高监测数据展现的及时性。
在出版“三网年鉴”的基础上，2018年起，上述3个监测网联合召开年度总结会，报告监测数据，使参会人员对3个监测网的数据有一个全面的了解，同时加强了多学科专业人员的沟通。
经专委会的多轮讨论，2018年建立了4个权重指数的评分标准：“三网联动”复合指标、细菌耐药权重指数、抗菌药物使用权重指数与医院感染权重指数，以期客观评价各医疗机构的相关指标，并作适当的横向比较，此评分标准已刊登于2018年底出版的《上海市细菌耐药、抗菌药物应用和医院感染监测报告（2017年度）》中，评分标准的更新版刊登于本书中。据此4个评分标准获得的结果，2019年上半年，专委会组织多学科专家到10家医疗机构进行了实地督导，每个小组由5名多学科成员组成，每家医疗机构督导半天。根据监测网的数据，找出主要问题，多学科专家实地考察后提出针对性的具可行性的整改、提升方案。督导的出发点是根据监测数据反映的问题，利用多学科的力量真心实意地协助被督导单位提升AMS水平，因而也受到被督导单位领导及专家的欢迎。在初步尝试后，计划于2019年下半年对更多的单位进行实地督导。
本监测报告对上海市2018年“三网”的监测结果进行全面总结、分析。上海市细菌真菌耐药监测网对所有被监测的分离菌的耐药状况做了总结报告，数据来自参与该网监测的上海市三级医院及二级医院。上海市抗菌药物临床应用监测网监测的医疗机构分三级医院、二级医院及社区医疗机构，该网对抗菌药物临床应用状况进行汇总、分析，并分别描绘了近5年各级被监测医疗机构抗菌药物临床应用的变化趋势。上海市医院感染防控与监测网总结报告的内容包括医院感染相关特色监测工作（锐器伤直报数据统计分析、引流瓶管理现状、血培养送检率调查）及医院感染常规监测（ICU目标性监测、围术期抗菌药物预防用药监测、血培养送检率调查、手卫生依从性及用品耗量监测、医院感染现患率调查）等。
希望广大读者特别是全国其他省、自治区与直辖市相关专业人员，不吝提出宝贵意见、建议，共同提高。我们坚信在多学科专家的共同努力下，我国的抗菌药物合理应用水平一定会得到提高，细菌耐药一定能得到遏制！
上海市卫生健康委员会抗菌药物临床应用与管理专家委员会
2019年6月
Shipping Overview:
• Shipping: Standard Domestic Shipping within the United States charges USD 4.99. Standard International Shipping from United Kingdom, Germany and Japan to the United States charges 14.99.
• Order Processing: Please allow 1-2 business days for order processing and preparation before shipment.
• Domestic Shipping: Orders within the U.S. are shipped via USPS or FedEx, depending on the origin of the product. The average transit time is 3-7 business days.
• International Shipping: Currently, we only ship within the USA.
• Tracking Information: Every order is trackable. You will receive a tracking number once your order has been shipped. Products may be shipped from various global fulfillment centers.
Shipping Delays:
Please note that shipping times may vary due to factors beyond our control, such as weather conditions, natural disasters, or peak holiday periods. While we strive to ensure timely delivery, the exact arrival time cannot be guaranteed and is managed by the shipping carrier.
Shipping Options:
-
Standard Delivery: Most orders are shipped within 3-7 business days. Larger items may utilize LTL shipping for safe handling.
-
Handling Time: We handle shipments on business days (Monday - Friday), with a preparation time of 1-2 days.
-
Additional Charges: Some items require additional shipping charges due to their size, weight, or special handling. These charges are specified on the product pages and are not eligible for shipping discounts.
-
Exclusions: Gift cards, packaging, taxes, and prior purchases do not count toward the minimum purchase requirement for free shipping. This offer is valid only for shipments to U.S. addresses, including Puerto Rico.
Delivery Details:
-
Estimates: Standard shipping within the US typically takes 3-7 business days. These are estimates and not guarantees.
-
Shipping Restrictions: We ship to all 50 states, Washington, DC, U.S. territories, and APO/FPO/DPO addresses. Shipping options vary based on the delivery address.
-
Remote Areas: Shipments to remote areas may incur additional charges or require pickup from a nearby shipping partner’s location.
Shipping Confirmation:
You will receive a shipping confirmation email with a tracking number as soon as your order is dispatched. If you do not receive this email immediately, please be assured that your items will arrive within the estimated delivery window provided at checkout.
Order Modifications:
If you need to cancel or modify your order, please contact our customer support immediately.
Issues with Delivery:
If your order shows as delivered but you have not received it, please contact the shipping carrier directly to resolve the issue. For persistent problems, contact our customer service at cs@everymarket.com.
Customer Support:
Our team is available 24/7 to assist you with any questions or concerns regarding your order. We are committed to ensuring a smooth shopping experience.
Return & Refund Policy Overview
Please review our return and refund policies below to ensure a smooth transaction process.
Return Policy
-
Duration: You have 30 days from receiving your item to initiate a return.
-
Condition: Items must be unworn, unwashed, with original tags and packaging intact.
-
Shipping Costs: Customers are responsible for return shipping costs.
-
Packaging: Ensure returned items are well-packaged to avoid damage during transit.
-
Tracking: Use a trackable and insured shipping method as we are not liable for items lost or damaged on return.
-
Initiating a Return: Contact us at cs@everymarket.com to start your return. We will provide a return shipping label and instructions upon approval. Returns without prior approval will not be accepted.
How to Return
-
Method: Returns must be sent back by mail to the address provided in the return instructions.
Return Label
-
Defective Products: Return labels are provided for defective items.
-
Non-Defective Returns: Customers are responsible for obtaining their return shipping label.
Product Conditions for Return
-
Eligible Products: Returns are only accepted for items in new condition.
Nonreturnable Items
Certain items are not eligible for return:
-
Electronic devices after 30 days (e.g., computers, laptops, Kindles)
-
Gift cards, prepaid game cards
-
Perishable goods, live insects, some jewelry, some health and personal care items
-
Customized or personalized products
-
Items with special shipping restrictions
Refund Policy
-
Window: Eligible products may be returned within 30 days of delivery for a refund.
-
Refund Method: Refunds are processed to the original payment method or as store credit for items purchased with gift cards.
-
Processing Time: Refunds are processed within 3-5 business days after we receive the return; please allow additional time for shipping and bank processing.
Claims
Inspect your order upon arrival and report any defects, damages, or incorrect items immediately to allow us to address the issue. For claims, contact our support team with details of the issue.
Exchange Policy
For the quickest service, return your original item and place a new order for the desired product once your return is accepted.
Return Address
EveryMarket Customer Service 2101 E Terra Ln, O'Fallon, MO 63366
Customer Support
Available 24/7 for any questions or assistance needed:
-
Phone: +1 636-312-5925
-
Email: cs@everymarket.com
Oops!
Sorry, it looks like some products are not available in selected quantity.