480例住院患者抗菌药物应用与分析

Analysis of Antibiotic Use in 480 In-patient Cases

目的 探讨医院抗菌药物应用情况及用药合理性。方法 随机抽取 2 0 0 3年 1月至 3月 480份住院病历进行回顾性调查。对其中使用了抗菌药物的 3 91份病历的用药种类、方式、联合用药、用药目的、疗程、指征、阳性菌株的耐药情况等进行统计 ,并就存在问题提出相应对策。结果 抗菌药物使用率为 82 % ,治疗用药占 45 % ,预防用药占 5 5 %。内科系统 75 %为治疗用药 ,外科系统 80 %为预防用药。抗菌药物使用例次数为 63 5例次。预防用药中单一用药占 81% ,二联用药占 18% ,三联用药占 1% ;治疗用药中单一用药占 42 % ,二联用药占 49% ,三联用药占 8% ,四联用药占 1%。针剂型抗菌药物使用量排在前 4位的分别是头孢菌素类、青霉素类、氨基糖苷类、喹诺酮类。对治疗用药的病例送检率为 3 9% ,阳性率为 41% ,真菌排在首位。抗菌药物合理应用中合理与基本合理占 62 % ,不合理占3 8%。不合理应用以给药方式、途径不正确、围术期用药时间偏长为主。结论 抗菌药物管理是个系统工程 ,要加强抗菌药物知识更新培训和医务人员职业道德教育 。

Objective To survey antibiotic use and its rationality in clinical settings.Methods Medical records of 480 in-patients between January and March of 2003 were randomly reviewed for retrospective studies.Analysis with regard to drug category,route,combination,purpose,duration,indication and resistance was conducted and solutions were proposed for the existing problems.Results The incidence of antibiotic use was 82%.45% of the cases were intended for active treatment,55% for preventive regimen.75% of the cases in internal medicine were for active treatment whereas 80% were surgical prophylaxis.The total number of antibiotics use was 635 cases.In terms of preventive use,single drug comprised 81%,two-drug 18% and three-drug 1%.As for active treatment,single drug consisted of 42%,two-drug 49% and three-drug 8% and four-drug 1%.The four leading injectable antibiotics included cephalosporines,penicillin,aminlglycosides and fluoroquinolones.Microbiological cultures were conducted in 39% of the cases with 40% being positive and fungus being the most common pathogen.Regarding rationality of antibiotic use,justified and partially justified cases comprised 61.9% while irrational cases made up 38.1%.Improrer routes and prolonged use of perioperative antibiotics were the dominant causes in those cases.Conclusion To improve antibiotic administration,systematic efforts are required to keep the medical staff updated of antibiotic principles and strengthen the ethics training in addition to furthering the health system reform.