综合干预措施对医院抗菌药物临床应用管理的成果分析

Effects of special management and pharmaceutical intervention for antibacterials

目的 分析评价新疆维吾尔自治区人民医院在抗菌药物临床应用专项整治活动干预前后抗菌药物的使用情况和综合干预的效果.方法 将抗菌药物的临床应用情况分为整治前（2011年1-12月）、整治后（2012年1-12月）,对抗菌药物的费用比例、使用强度[AUD]、用药频度（DDDs）等进行统计、分析.结果 抗菌药物的AUD由整治前39.61 DDDs/（100人·d）（466628/1 177 214）下降至整治后24.77 DDDs/（100人·d）（384 115/1 550 762）（P＜0.05）;住院患者抗菌药物使用率由整治前55.10％ （54 189/98 347）下降为整治后36.47％ （44 081/120 870）（P＜0.05）;门诊患者抗菌药物处方比例由整治前16.85％ （210 159/1 247 235）下降至整治后4.98％（67 138/1 348 153）（P＜0.05）;Ⅰ类切口手术患者预防使用抗菌药物比例由整治前70.50％ （69 335/98 347）下降至整治后14.44％（17 454/120 870） （P ＜0.05）.整治后一、二、三代头孢菌素、氨基糖苷类、大环内酯类、青霉素类、其他β内酰胺类的DDDs降低16.19％ ～ 58.21％,喹诺酮类的DDDs百分比增加57.22％.整治后限制使用类药的DDDs和构成比下降（P＜0.05）,非限制使用类与特殊使用类药DDDs和构成比均略有上升（P＜0.05）.整治前抗菌药物使用频度排名前10位的药物为注射用头孢甲肟、注射用阿莫西林克拉维酸钾、注射用头孢哌酮舒巴坦钠、注射用头孢硫脒、盐酸莫西沙星注射液、乳酸左氧氟沙星注射液、注射用头孢美唑、注射用头孢孟多酯钠、注射用头孢呋辛钠和注射用头孢吡肟,其DDDs分别为50 204、41 357、35 519、31 696、26 471、24 911、20 798、16 506、12 360、8 029.整治后抗菌药物使用频度排名前10位的药物为注射用头孢甲肟、左氧氟沙星注射液、注射用阿莫西林克拉维酸钾、注射用头孢孟多酯、注射用头孢硫脒、注射用头孢哌酮钠舒巴坦钠、注射用头孢美唑钠、头孢哌酮钠他唑巴坦钠、注射用青霉素、甲硝唑氯化钠注射液,其DDDs分别为50 018、34 295、30 367、27 536、22 500、19 962、13 552、10 622、8 781、7 665.整治后非限制使用类药和特殊使用类的DDDs分别为50 741 （22.52％）、27 536（12.22％）,均略高于整治前[37 271（13.91％）、24 535（9.16％）]（均P＜0.05）,限制使用类DDDs为147 021 （65.26％）,明显低于整治前[206 045（76.93％）]（均P＜0.05）.结论 通过实施抗菌药物专项整治和各项药学综合干预措施,本院各项抗菌药物临床应用指标明显改善,且全部指标已符合卫生部规定.

Objective To investigate the application of antibacterial before and after special rectification.Methods The utilization of antibacterials in our hospital before intervention （January to December）in 2011 and after intervention（January to December） in 2012 was analyzed statistically in terms of antibacterials cost proportion,AUD,DDDs,etc.Results AUD decreased from 39.61 DDDs/（100 cases · d） （466 628/1 177 214）before intervention to 24.7 DDDs/（100 cases · d） （384 115/1 550 762） after intervention（P ＜ 0.05） ; the utilization ratio of antibacterials in the inpatients decreased from 55.10％ （54 189/98 347） before intervention to 36.47％ （44 081/120 870） after intervention （P ＜ 0.05） ; the ratio of antibacterial prescription in outpatients decreased from 16.85％ （210 159/1 247 235） before intervention to 4.98％ （67 138/1 348 153） after intervention（P ＜ 0.05） ; the prophylactic application ratio of antibacterial in type Ⅰ incision operation declined from 70.50％ （69 335/98 347） before intervention to 14.44％ （17 453.6/120 870） after intervention（P ＜ 0.05）.The DDDs of the first,second and third generation cephalosporins aminoglycosides and macrolides were decreased from 16.19％ to 58.21％,the DDDs of quinolones were increased by 57.22％.The DDDs and proportion of antibiotics for restrictive use were Significantly decreased（P ＜ 0.05）.The DDDs and proportion of antibiotics for nonrestrictive use and special use were slightly increased （P ＜ 0.05）.Before the renovation,DDDs of top 10 antimicrobial drugs were Cefmenoxime,amoxicillin and clavulanate potassium injection,cefoperazone sulbactam sodium for injection cefathiamidine,moxifloxacin hydrochloride injection,levofloxacin lactate injection,injection cefmetazole,injectable ester cefamandole sodium,cefuroxime sodium for injection and injection of cefepime,which DDDs were 50 204,41 357,35 519,31 696 26 471,24 911,20 798,16 506,12 360,8 029.After the renovation,DDDs of top 10 antimicrobial drugs were Cefmenoxime,levofloxacin,amoxicillin and clavulanate potassium injection,injection-shaped spore Meng polyester,cefathiamidine injection,injection cefoperazone sulbactam,cefmetazole sodium for injection,cefoperazone sodium and tazobactam sodium for injection of penicillin,metronidazole sodium Chloride Injection,its DDDs were 50 018,34 295,30 367,27 536,22 500,19 962,13 552,10 622,8 781,7 665 ; after renovation unrestricted use of medicines and special classes DDDs were 50 741 （22.52％）,27 536 （12.22％）,were slightly higher than the previous regulation [37 271 （13.91％） vs 24535 （9.16％）] （both P ＜ 0.05）,restricting the use of DDDs class is significantly lower than before renovation [147 021 （65.26％） vs 206 045 （76.93 ％）,P ＜ 0.05].Conclusions The special rectification promotes rational use of antibacterial in our hospital.The management and pharmaceutical intervention improves the index of antibacterials use which is partly up to the specification of Ministry of Public Health.