2010―2015年北京市综合医院抗生素使用现状

Antibiotics use in general hospitals in Beijing from 2010 to 2015

目的了解2010―2015年北京市各级综合医院抗生素的使用情况,为抗生素管理和使用提供科学依据。方法本研究数据源于北京市职工医疗保险数据库。采用分层随机抽样,选取北京市一级医院18家,二级医院9家,三级医院12家。提取入选医院2010年1月―2015年12月门诊及住院的药物处方数据,分析门诊抗生素处方比例、住院抗生素使用率和抗生素处方占比等指标。结果2010―2015年,北京市综合医院门诊抗生素处方比例从16.0%下降至10.8%,住院抗生素使用率从70.9%下降至53.0%,其中二、三级医院两项指标降幅均高于一级医院。门诊广谱抗生素处方占比在70.0%左右波动,住院广谱抗生素处方占比从61.8%上升至63.9%,其中二级医院住院广谱抗生素使用占比增幅较大。头孢菌素类、喹诺酮类、青霉素类是北京市综合医院最常用的三类抗生素,尤其以二、三代头孢为主。结论2010―2015年,北京市综合医院抗生素使用情况总体呈不断改善趋势,其中一级医院应作为重点监测对象。广谱抗生素处方占比居高不下,尤其在二级医院,需引起重视。

Objective To know the situation of the use of antibiotics in general hospitals at all levels in Beijing from 2010 to 2015,and to provide a basis for antibiotics management and policy formulation.Methods Data of this study were from Beijing medical insurance database for employers(BMCDE).Based on stratified random sampling,18 primary hospitals,9 secondary hospitals and 12 tertiary hospitals in Beijing were selected.Drug prescription data of outpatient and inpatient departments from January 2010 to December 2015 in each hospital was extracted from BMCDE.The proportion of antibiotic prescriptions in outpatient,the rate of patients who receiving antibiotic therapy in inpatient and the percentages of commonly antibiotics prescribed were analyzed.Results From 2010 to 2015,the proportion of antibiotic prescriptions in outpatient of general hospital decreased from 16.0%to 10.8%,and the rate of patients who receiving antibiotic therapy in inpatient decreased from 70.9%to 53.0%.The reduction in secondary and tertiary hospitals was higher than that in primary hospitals.The proportion of broad-spectrum antibiotics prescription in outpatient fluctuated around 70.0%,while the proportion in hospital increased from 61.8%to 63.9%.The overuse of broad-spectrum antibiotics in secondary hospitals was serious.Cephalosporins,quinolones and penicillin were the three most commonly used antibiotics,especially the second and third generation cephalosporins.Conclusions From 2010 to 2015,in general hospitals in Beijing,the use of antibiotics showed a trend of continuous improvement,and primary hospitals should be the focus of monitoring.The proportion of broad-spectrum antibiotics prescriptions is still high,especially in secondary hospitals,which should be paid attention to.