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    Home > Active Ingredient News > Infection > What is the role of increasing the pathogenic inspection rate in standardizing the clinical application of antimicrobial drugs?

    What is the role of increasing the pathogenic inspection rate in standardizing the clinical application of antimicrobial drugs?

    • Last Update: 2021-05-09
    • Source: Internet
    • Author: User
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    In order to further strengthen medical quality and safety management and build a high-quality and efficient medical quality management and control system, the National Health Commission issued the "2021 National Medical Quality and Safety Improvement Goals" (hereinafter referred to as the "Goals") at the beginning of the year, proposing ten national standards Medical quality and safety improvement goals and corresponding specific explanations and core strategies to achieve the goals.
    Among them, "improving the rate of pathogens before antibacterial drug treatment in hospitalized patients" is clearly listed as one of the goals, and procalcitonin (PCT) testing Also mentioned in it.

    It is imperative to strengthen the main responsibility of medical institutions and increase the pathogenic inspection rate before antibacterial treatment.
    The pathogenic inspection rate before antibacterial treatment refers to the hospitalized patients who use antibacterial drugs for the purpose of treatment, and the pathogenic test specimens before the use of antibacterial drugs The proportion of the number of cases submitted for inspection to the total number of cases treated with antimicrobials during the same period can reflect the standard of antimicrobial treatment and use of inpatients in medical institutions.

    According to the 2021 National Medical Quality and Safety Improvement Target Statement (hereinafter referred to as the "Description"): increase the pathogenic inspection rate before antimicrobial treatment (especially antimicrobial drugs above the restricted use level), and increase the rate of sterility samples submitted for inspection , Can effectively improve the scientific and standardized use of antibacterial drugs, which is of great significance for curbing bacterial resistance, improving treatment effects and protecting the health rights and interests of the people.

    At the same time, the "Explanation" also clarified that the pathogenic test items should include: bacterial culture, fungal culture; procalcitonin detection, interleukin-6 detection, fungal 1-3-β-D glucan detection (G test), etc.

    According to the instructions of the National Health Commission, medical institutions assume the main responsibility for the improvement of the annual target, and advocate the establishment of a special working group composed of multiple departments such as inspection, pharmacy, clinical departments, hospital sense, etc.
    , to achieve effective multi-disciplinary collaboration, especially focusing on establishing The goal is to improve the scheduling and incentive and restraint mechanism of work, and fully mobilize the enthusiasm of relevant managers and medical staff.Serving as a member of the Antibacterial Drug Professional Group of the Expert Committee on Rational Drug Use of the National Health Commission, and a consultant of the Shanghai Antibacterial Drug Clinical Application and Management Expert Committee, Professor He Lixian from Zhongshan Hospital said: "In terms of the management of clinical application of To further strengthen, hospitals at all levels should strengthen the education of relevant medical staff on the use of antimicrobial drugs, and further tighten the grant and management of antimicrobial drug prescription rights, and decompose and refine it to every person in charge; at the same time, the pharmacy department and the infection control department As an important'line of defense' for infection control in hospitals, we should continue to strengthen our professional and technical level and maintain close cooperation with various functional departments of the hospital to ensure that the etiology inspection rate meets the national standard and provide the basis for clinical antibacterial drug target treatment to the greatest extent.

    " Regarding the use of antimicrobial drugs, China has successively introduced a series of standardized programs in recent years: The "Administrative Measures for the Clinical Application of Antimicrobial Drugs" was officially promulgated in 2012, and antimicrobial drugs were divided into non-restricted use, restricted use and Special use of three-level management; at the same time, the etiology inspection rate has been clearly included in the hospital's review and assessment index system.

    The "Third-level Hospital Evaluation Standard (2020 Edition)" clearly states that the review standard for the pathogen inspection rate before antibacterial drug treatment in hospitals refers to the evaluation index of "Nosocomial Infection Management Medical Quality Control Index (2015 Edition)": inpatients are required to be antibacterial Before the drug is used, the pathogen inspection rate is not less than 30%, the restricted use level is not less than 50%, and the special use level is not less than 80%.

    Pay attention to the PCT detection of procalcitonin and standardize the clinical application of antibacterial drugs.
    Professor Lixian He said: “Academics and clinical practice have always emphasized that anti-infective treatment needs to consider and evaluate the triangle relationship between patient-microbes and drugs.
    There is more attention and research on microorganisms and drugs, and the evaluation indicators are clear and feasible.
    The evaluation of patients (host) still mainly depends on clinical symptoms and signs.
    Laboratory indicators are mainly white blood cells and C-reactive protein.
    For some infections, refer to red blood cell sedimentation.
    Rate (erythrocyte sedimentation rate), sensitivity and specificity are not high.

    In recent years, the research and development of biomarkers have opened up a new field for evaluating the host response of infection and anti-infection treatment, especially the discovery, in-depth research and wide application of PCT The practice shows that it is of great help in guiding clinical antibacterial treatment and antibacterial drug management.

    In recent years, the management of antibacterial drugs in my country has been effective, and the use rate and intensity of use have dropped significantly.

    However, it must be understood that this achievement was mainly achieved by relying on instructional management (mainly prescription restrictions and variety restrictions) when there was basically no management.
    Improper clinical use means misuse, underuse, and The key issues of improper use, such as excessive treatment (overexposure), have not been resolved.

    Although procalcitonin PCT does not belong to the scope of traditional pathogenic testing, if PCT can be used in combination with clinical and other laboratory parameters to distinguish bacterial infections from viral infections, strengthen the comprehensive evaluation of the stages of infection, early initiation and timely contraction or It is obviously a feasible way to stop antibacterial treatment, so as to improve the antibacterial treatment of patients, avoid excessive exposure to antibacterial drugs, reduce the selective pressure of resistance, and promote more scientific management of antibacterial drugs.

    "In recent years, with the continuous strengthening of antibacterial drug management in China, the clinical value of PCT in the diagnosis and treatment of infectious diseases and guiding the use of antibacterial drugs has become increasingly prominent.

    In the second half of last year, the Infectious Disease Professional Committee of China Medical Education Association organized relevant experts to jointly release The "Expert Consensus on Procalcitonin Guiding the Clinical Rational Use of Antibacterial Drugs" (hereinafter referred to as the "Consensus") to further guide the clinical application of PCT and help it play greater value in regulating the use of antibacterial drugs.

    Recommendations of the "Consensus", clinical When unexplained infections and sepsis are suspected, PCT testing is recommended to help further confirm the diagnosis of bacterial infectious diseases; for patients with suspected lower respiratory tract infections, when PCT ≥ 0.
    25 μg/L, it indicates that the possibility of bacterial infection is high It is recommended to start empirical antibacterial treatment; for patients suspected of sepsis, empirical antibacterial treatment should be started immediately.
    When
    PCT ≥ 0.
    5 μg/L, it is helpful for the diagnosis of sepsis.

    Dynamic monitoring of PCT level changes can assist in guiding antibacterial drugs Treatment to reduce the occurrence of bacterial resistance.

    The "Consensus" clarifies that for patients who have initiated antimicrobial therapy, it is recommended to monitor the dynamic changes of PCT reasonably and evaluate the therapeutic effect in time: For patients with non-severe lower respiratory tract infections, when PCT drops to 0.
    25μg/L or the peak concentration is below 80%, In the case of stable disease, it is recommended to stop antibacterial drugs; for patients with severe infection in ICU who are receiving antibacterial treatment, when the PCT drops to 0.
    5μg/L or the peak concentration is below 80%, it is recommended to stop antibacterial drugs.

    Accurate and efficient detection of inflammatory markers is an important reference for supporting clinical decision-making in a timely manner and guiding the rational use of antibacterial drugs.

    As a global leader in the field of in vitro diagnostics, Roche Diagnostics Elecsys® BRAHMS PCT test is based on electrochemiluminescence technology.
    It has the performance advantages of fully automatic, full quantification, high accuracy, and good repeatability.
    It only needs 18μl sample volume.
    Achieve detection in the range of 0.
    02-100μg/L within minutes, which can effectively guide the clinical management and application of antibacterial drugs.

    Typesetting: Li Hui Editor: Xin Ya Review: Xu Fengyan For more content, please click: Through Life and Death, Love Does Not Fall | 2021 [Qing·Medical] "I have a date with a good book, a good book in Chinese medical circles" reading will take you to read life Fill in the questionnaires and receive credits for the chapters of China’s cataract cognition and treatment status survey launched "Physician Daily" award-winning survey waiting for you to participate in "Physician Daily" submission Public email: yishibao2017@163.
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