Antibacterial Drug Management Enters AMS Era
Introduction: AMS strategy became the core topic at the 4th China Medical Institutions Antimicrobial Drug Management Summit Forum held in Beijing recently. AMS strategy is to achieve the best effect of clinical treatment and infection prevention and reduce unnecessary medical expenses through administrative control, sense control participation, and the establishment of three major technical support systems composed of infectious disease physicians, clinical microbiology inspectors and clinical pharmacists.
Yu Yunsong, vice president of run run run hospital affiliated to Medical College of Zhejiang University, called for the active practice of AMS strategy, standardize the drug selection, dosage and medication time of antibacterial treatment, and establish a scientific and refined long-term management mechanism.
"" Improve the level of management refinement
At present, China's antimicrobial management guidance policy reflects many ideas of AMS strategy, but due to the relevant indicators, technical standards or recommendations are not clear enough, the level of management refinement is still insufficient. There is an urgent need for fine management of antibacterial drugs in China, and the application indicators of antibacterial drugs should be refined by specialty, so as to make the policy more scientific and operable.
"The fine management of antibacterial drugs first needs to improve the capacity building of China's anti-infection team." Chen Baiyi, director of the Department of Infectious Diseases of the First Affiliated Hospital of China Medical University, said, "The construction of a long-term mechanism for the clinical management of antibacterial drugs requires the technical and professional support of clinical infection doctors, so that they must not only participate in the clinical management of antibacterial drugs., And it is necessary to gradually individualize clinical anti-infective treatment by evaluating pathogens and drug resistance. Only by achieving individualized treatment of clinical anti-infection can we achieve the diversification of clinical use of antibacterial drugs, thereby delaying the emergence of antibacterial drug resistance."
Establish three perfect technical support systems
The management of antibacterial drugs needs to start from the construction of key disciplines and other aspects. Among them, infectious disease physicians, clinical microbiology laboratory personnel and clinical pharmacists are the three major technical supports for clinical management of antibacterial drugs.
In our country, the construction of infectious diseases department in most hospitals is not comprehensive, which is mainly reflected in the fact that the department staff are not familiar with microbial knowledge and lack of experience in the treatment of infectious diseases, so it is difficult to play a guiding role in clinical departments.
In the face of this challenge, Hu Bijie, director of the Department of Infectious Diseases and Hospital Infection Management of Zhongshan Hospital affiliated to Fudan University, believes that we should start with department construction and personnel training: setting up infection clinics and infection wards in hospitals above the second level, equipped with a certain number of infectious disease Junior College doctors with the ability to diagnose and treat bacterial and fungal infections are responsible for providing technical guidance on the clinical application of antibacterial drugs in various clinical departments of the institution, participate in the management of clinical application of antibiotics. At the same time, strengthen the training of staff in the department of infectious diseases, and comprehensively improve the level of diagnosis and treatment.
In the aspect of clinical microbiological examination, at present, the laboratory equipment of many primary medical institutions in China is still relatively backward, and the proportion of microbial samples submitted for inspection is low and the quality is not high, which leads to the work of etiological diagnosis and bacterial drug resistance technical support can not be carried out in an all-round way.
At the same time, anti-infection professional clinical pharmacists should also play a greater role in the management of clinical application of antibiotics and the treatment of infectious diseases. It is urgent to strengthen the training and development of anti-infection clinical pharmacists in China, so that they can better participate in the clinical rational drug use, and play the professional and technical role of drug treatment experts in the anti-infection treatment team.
Optimization of bacterial resistance monitoring system
In the past 10 years, the problem of bacterial resistance has attracted great attention from relevant departments of our government, and the monitoring of antibacterial resistance has been carried out nationwide. As early as 2005, my country established the most recognized bacterial resistance monitoring system in China at this stage:
The National Bacterial Resistance Monitoring Network (CARSS), which adjusts the quality of data reporting every year, has now increased to 1426 hospitals. In the past 10 years, the drug resistance monitoring network has gradually improved the reporting system and organizational management structure, and established a quality control center to provide services and support for antibacterial drug management decisions and rational drug use.
"At the same time, the national antibacterial drug clinical application monitoring network has been continuously improved and expanded in the past 10 years, providing a basis for the country to formulate management policies." Yu Yong, consultant of the National Antimicrobial Clinical Application Monitoring Network of the Pharmaceutical Affairs Management Research Department of the Hospital Management Institute of the National Health and Family Planning Commission, and director of the Laboratory Department of the First Affiliated Hospital of the PLA General Hospital, said that in order to promote the rational use of antimicrobial drugs, antimicrobial drug management requires medical institutions at or above the second level. All institutions must carry out the monitoring of the clinical application of antimicrobial drugs, which together with bacterial drug resistance monitoring has become the scientific basis for antimicrobial drug management. However, scientific, refined and standardized application monitoring still has a long way to go.
Li Guanghui, director of the Department of Infection Management of Huashan Hospital affiliated to Fudan University and deputy director of the Institute of Antibiotics of Huashan Hospital, said that in order to promote the monitoring of bacterial drug resistance in my country, secondary medical institutions must establish clinical application monitoring and drug resistance monitoring of antibacterial drugs, and cooperate in multiple fields. Regular analysis and interpretation provide basis for management and medication; improve data processing efficiency, so that the results can be updated and published in real time; in addition, medical institutions should use the national data network platform to establish their own data monitoring network, and use information technology to process and analyze data such as bacterial resistance trends and the use of antibacterial drugs.