某“三甲”医院2012-2013年抗菌药物使用强度分析

Analysis of Antibacterial Use Density in a Third-grade Class-A Hospital during 2012-2013

目的:为抗菌药物长效管理提供参考。方法:回顾性收集该院2012-2013年抗菌药物的使用数据,采用Excel 2003进行统计,以限定日剂量(DDD)为单位,计算抗菌药物的使用强度(AUD),并进行比较、分析。结果:该院AUD值控制较平稳,2012、2013年的AUD值分别为40.46、42.56 DDDs/(100人·d),虽较接近目标,但仍有一定距离。2013年有一半科室的AUD值较2012年升高,其中呼吸科、重症医学科、皮肤科、康复科及烧伤整形科的AUD值涨幅较大。AUD排前5位的抗菌药物种类保持不变,分别为青霉素类+酶抑制剂、第三代头孢菌素、喹诺酮类、第二代头孢菌素及青霉素类。AUD值排前20位的药物均为注射剂。2013年特殊使用级抗菌药物AUD值下降明显,而限制及非限制级抗菌药物的AUD值有所上升,且非限制级抗菌药物的AUD值上升较为明显,但非基本药物的AUD值远高于基本药物。结论:该院存在AUD值偏高、用药集中、广谱抗菌药物的使用率高等问题,应加强监管并优化抗菌药物使用品种,力争将AUD降至40 DDDs/(100人·d)以下。

OBJECTIVE： To provide reference for the long-term management of antibacterials. METHODS： In retrospective study, the data of the use of antibacterial were collected and analyzed by Excel 2003; the AUD was calculated and analyzed by tak- ing DDD as the unit. RESULTS： The AUD of the hospital was kept on an even level. The AUD were 40.46 and 42.56 DDDs/100 person/day in 2012 and 2013, respectively. It was more close to the target, but there was a certain distance. Compared with 2012, half of the departments＇ AUD increased in 2013. The AUD increased a lot in some departments, such as respiration department, ICU, dermatological department, rehabilitation department and burn department. The top 5 antibacterials in the list of AUD re- mained the same. They were penicillin/lactamase inhibitors, the third generation cephalosporin, quinolones, the second generation cephalosporin and penicillins. The top 20 antibacterial in the list of AUD were all injection. In 2013, the AUD of special use class antibacterial was reduced obviously. However, the AUD of antibacterials for unrestricted use and restricted use were increased. AUD of antibacterials for unrestricted use increased significantly. AUD of non-essential medicines was far higher than that of essen- tial medicine. CONCLUSIONS： There may be such problems as over high AUD, concentrated medication and high frequency of broad-spectrum antibacterial use. It is necessary to strengthen the supervision and management, optimize the types of antibacterial so as to keep the AUD under 40 DDDs/100 person/day.