抗菌药物不合理使用对住院费用的影响

Impact of misuse of antimicrobial therapies on inpatient costs

目的:评价抗菌药物使用的不合理性对住院费用的影响及其原因。方法:采用二阶段抽样,抽取我国5个地区省市10家医院2005年使用过抗菌药物的病例共1000份。分别采用多元线性回归模型和Logistic模型来评价抗菌药物不合理使用对住院费用的影响和抗菌药物不合理使用的危险因素。结果:共收集有效病例946例,抗菌药物不合理使用率为58.4%。在控制了其他影响因素后,抗菌药物不合理使用者的住院费用是合理使用者的1.55倍(P<0.01),其危险因素有预防用药(OR=2.929)、接受手术(OR=2.440)、住院时间较长(OR=1.021),保护性因素为在三级医院就医(OR=0.510)。结论:抗菌药物不合理使用会让患者的住院费用增加55%,严格预防和手术用药、缩短住院时间可减少抗菌药物的不合理使用。

Objective：To evaluate the impact of inappropriate antibiotic use on inpatients＇ cost during hospitalization.Methods：1 000 cases with antibiotic treatment were extracted from 10 hospitals of 5 provinces in China in 2005.We created multivariate linear regression model for hospital cost and Logistic regression model for evaluation of rationality in antibiotic use.Results：We collected 946 valid cases.Rate of inappropriate antibiotic use was 58.4%.Costs of inpatients with inappropriate antibiotic use was 1.55 times of the ones with appropriate use（P0.001）.Risk factors included antibiotic prophylaxis（OR=2.929）,medication for surgery（OR=2.44）,long hospital stay（OR=1.021 for every prolonged day）and regional factors.Protection factor was in tertiary hospital（OR=0.510）.Conclusion：Inappropriate antibiotic use could add 55% unnecessary cost on inpatients.Efforts to control misuse of antibiotics such as regulating antibiotic prophylaxis and medication for surgery,and decreasing length of stay should be pursued.