我国三级医院急诊抗菌药物使用情况分析

Antibiotic use in emergency departments of class III general hospitals in China

目的了解近年来我国三级医院急诊抗菌药物使用情况。方法利用全军合理用药监测网中三级医院2014年10月1日至2016年12月31日的全部急诊处方数据，包括全国30个省（自治区、直辖市）114家三级医院，共10260595张处方。采用WHO解剖一治疗一化学的药物分类系统和限定日剂量（DDD）对抗菌药物进行分类并计算抗菌药物的用药强度。采用残差自回归模型对急诊抗菌药物使用的变化趋势和季节波动进行分析。结果我国三级医院急诊抗菌药物处方率为27．82％，其中抗菌药物联用处方所占比例为25．58％，注射用抗菌药物处方占60．59％。急诊病例次均抗菌药物使用强度为81．84DDD／100人次，且急诊抗菌药物以广谱抗菌药物为主，三代和二代头孢菌素、喹诺酮类和大环内酯类抗菌药物处方占比分别为23．83％、21．68％、19．17％和7．89％。趋势分析表明，近年来急诊抗菌药物处方率和抗菌药物次均使用强度均呈增长趋势（均P〈0．05），同时抗菌药物使用的季节波动特征明显，冬季急诊抗菌药物处方率和次均使用强度均高于其他季节，差异有统计学意义（均P〈0．05）。结论我国三级医院急诊抗菌药物处方率整体上控制在较低水平，但广谱抗菌药物和注射用抗菌药物占比较高，且急诊抗菌药物使用有显著的增长趋势。

Objective To investigate the utilization of antibiotics in emergency departments （EDs） of class III general hospitals in China. Methods Data from a national monitoring network for rational use of drugs was used. The data included prescriptions of EDs from 114 class III general hospitals in 30 provinces （autonomous regions, municipalities） of China. A total of 10 260 595 prescriptions from October 1, 2014 to December 31, 2016 were extracted. The Anatomical Therapeutic Chemical Classification/Defined Daily Dose （DDD） system was used for the classification of antibiotics and calculation of antibiotic use intensity. An auto-regression model was used to analyze the trend over time and seasonal variation of antibiotic use in EDs. Results The rate of antibiotic prescriptions was 27.82% in EDs, among the antibiotics prescribed, 25.58% were for the combination therapy with 2 or more antibiotic agents, and injectable antibiotic prescriptions accounted for 60.59%. Besides, the number of DDDs per 100 patient visits was 81.84. Broad-spectntm agents were the most commonly used antibiotics, among which the second and third generation cephalosporins, quinolones and macrolides accounted for 23.83%, 21.68%, 19.17% and 7.89% of all prescribed antibiotics, respectively. The use of antibiotics, including prescription frequency and use intensity, in EDs had a slight but significant increase tendency （P〈0.05）, and the seasonal variation of antibiotic use in EDs was obvious, characterized by the highest frequency and intensity of antibiotic use in winter, the differences were significant （P〈0.05）. Conclusion The antibiotic prescription rate in EDs of class III general hospitals in China was controlled at a low level, but the proportions of broad-spectrum antibiotics and injectable antibiotics were high, and a significant increase trend in antibiotic use in EDs was found.