网络在线审批流程实施前后我院特殊使用级抗菌药物使用情况及细菌耐药分析

Application of Antibacterial Drugs for Special Use and Bacterial Resistance in Our Hospital before and after the Implementation of Network Online Approval Process

目的:分析网络在线审批流程实施前后我院特殊使用级抗菌药物使用指标和耐药率,为改进特殊使用级抗菌药物管理方法,促进其合理使用提供参考。方法:采用回顾性调查方法,调查我院2012~2015年抗菌药物和特殊使用级抗菌药物用量、销售金额、使用率、使用强度、微生物标本送检率及主要致病菌对特殊使用级抗菌药物的耐药率等。结果:我院特殊使用级抗菌药物审批会诊流程由手工申请单递送会诊发展为网络在线审批会诊;从2012~2015年我院抗菌药物使用指标略呈上升,住院患者抗菌药物人均费用由1 602.85元上升至1 888.63元,住院患者抗菌药物使用强度由54.50 DDDs/(100人·天)上升至65.47DDDs/(100人×天);特殊使用级抗菌药物使用金额占比2013年最低为13.90%,2015年最高为17.34%;特殊使用级抗菌药物使用强度由4.85 DDDs/(100人×天)上升至6.37 DDDs/(100人×天);特殊使用级抗菌药物治疗前微生物送检率由85.5%上升至90.0%;主要病原菌为金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌,主要致病菌构成比例均有微弱变化;除了金黄色葡萄球菌,其他四种病原菌对特殊使用级抗菌药物的耐药率呈上升趋势,鲍曼不动杆菌对头孢吡肟和碳青霉烯类的耐药率超过了50%。结论:我院还需对特殊使用级抗菌药物在线审核流程进行加强和管理,真正做到严控特殊级抗菌药物不合理滥用现象。

Objective ： To analyze the indicators and resistance rate of antibacterial drugs for special use in our hospital before and after the implementation of network online approval process to provide reference for the management and rational use of antibacterial drugs for special use. Methods： A retrospective analysis was performed, and the consumption amount, sales amount, utilization ratio, AUD, submission rate of microbial specimen and resistance rates for the main pathogenic bacteria of antibacterial drugs and ones for special use were investigated during 2012 and 2015 in our hospital. Results： The approval process of antibacterial drugs for special use developed from handwork to network online. The consumption amount of antibacterial drugs increased slightly year by year from 2012 to 2015 in our hospital, the mean expense of antibacterial drugs for the inpatients increased from 1 602.85 yuan to 1 888.63 yuan,and AUD increased from 54.50 DDDs/（ 100 persons x d） to 65.47 DDDs/（ 100 persons x d）..The sales amount proportion of antibacterial drugs for special use （ 13.90% ） was the lowest in 2013, and the highest （ 17.34% ） in 2015, and AUD increased from 4.85 DDDs/ （ 100 person x d）to 6.37 DDDs/（ 100 person x d）, and the submission rate of microbial specimen before the treatment increased from 85.5 % to 90.0%. The main pathogenic bacteria were Staphylococcus aureus, Escherichia coli, Klebsiella pneumonia, Pseudornonas aeruginosa and Acinetobacter baumannii, and their ratio had slight change. Except Staphylococcus aureus, the resistance rate of the other four pathogenic bacteria kept increasing, and the resistance rates of Acinetobacter baumannii to cefepime and carbapenems were over 50%. Conclusion： The approval process management of antibacterial drugs for special use must be strengthened in order to truly a- chieve reasonable use of antibacterial drugs for special use.