2015—2020年浙江省某县基层公立医疗机构门诊抗菌药物的使用分析

Trend of antibiotics usage among outpatients in primary public medical institutions in a county of Zhejiang Province,from 2015 to 2020

【目的】了解浙江省某县基层公立医疗机构2015—2020年门诊患者抗菌药物使用情况,为进一步规范县域医疗机构抗菌药物的临床应用提供依据。【方法】提取该县医疗机构电子病历数据共享平台系统中2015—2020年所有基层公立医疗机构的门诊记录和处方记录,描述各年度门诊患者抗菌药物使用率和使用品种数。根据药品解剖学、治疗学及化学分类系统(ATC)、抗菌药物临床应用分级及抗菌药物剂型分类,分析不同类别抗菌药物使用情况,并利用年度变化百分比(APC)分析抗菌药物使用率的时间变化趋势。在各年度抗菌药物处方中,比较针对不同用药原因和患者的处方比例,比较各年度抗菌药物处方的结构。【结果】2015—2020年该县146家基层公立医疗机构共开具处方2861438张,其中抗菌药物处方为314642张,抗菌药物总体使用率为11%。抗菌药物使用率呈逐年下降趋势(从2015年的14.23%降至2020年的7.59%,APC=−11.51%,95%CI=−0.01%~−21.7%,t=−12.05,P<0.001)和明显的季节变化特点(冬春季较高、夏秋季较低)。2015年使用最多的抗菌药物为注射用头孢西丁钠,2016—2020年使用最多的抗菌药物为头孢呋辛酯。头孢菌素类(APC=−11.06%,95%CI=0~−20.89%,t=−22.233,P<0.001)、喹诺酮类(APC=−9.74%,95%CI=0~−18.53%,t=−7.652,P=0.002)、大环内酯类(APC=−17.52%,95%CI=0~−17.52%,t=−3.626,P=0.022)和林可酰胺类药物(APC=−49.01%,95%CI=0~−74%,t=−3.35,P=0.029)的使用率均呈逐年降低趋势。各年度抗菌药物处方在用药原因(χ^(2)=9458.427,P<0.001)以及患者年龄(χ^(2)=5421.709,P<0.001)和性别(χ^(2)=245.322,P<0.001)的分布上存在差异。50.69%的抗菌药物处方用于治疗呼吸性系统疾病,2015年最高(57.67%),2020年最低(34.93%)。58.37%的患者年龄50~70岁,<50岁患者的构成比逐年减小(2015年17.83%,2020年6.64%),而>70岁患者的构成比逐年增大(2015年24.1%,2020年38.41%)。【结论】浙江省某县公立医疗机构门诊患者抗菌药物使用率呈现逐年下降趋势,但是高于全国二级以上医院,也高于经济发达地区的基层医疗机构,应积极加强对该县抗菌药物临床使用的管理和监测。

[Objective]To understand the usage of antibiotics in outpatients in a county of Zhejiang Province from 2015 to 2020,so as to provide a basis for further standardizing the clinical application of antibiotics in this region.[Methods]Outpatient records and prescription records of 146 public medical institutions from 2015 to 2020 were extracted from the electronic medical record data sharing platform system of medical institutions in a county of Zhejiang Province.The utilization rates and the number of types of antibiotics used in outpatient patients were described.According to the drug anatomy,therapeutic and chemical classification system(ATC),clinical application classification and dosage form,the use status of different types of antibiotics was observed.The annual percentage change(APC)was used to analyze the time trend of antibiotic use.Among the antibiotic prescriptions in each year,the proportions of prescriptions aimed for different use reasons and patients were compared to analyze the changes in the structures of antibiotic prescriptions.[Results]During 2015‒2020,a total of 2861438 prescriptions were issued in 146 primary public medical institutions in this county,including 314642 prescriptions for antibiotics,and the overall utilization rate of antibiotics was 11%.The utilization rate of antibiotics showed a decreased trend across the years(from 14.23%in 2015 to 7.59%in 2020,APC=−11.51%,95%CI=−0.01%‒−21.7%,t=−12.05,P<0.001)and an obvious seasonal variation character(higher in winter and spring,lower in summer and autumn).Cefoxitin sodium for injection was the most used antibiotic in 2015,and cefuroxime was the most used antibiotic from 2015 to 2020,respectively.The utilization rates of cephalosporins(APC=−11.06%,95%CI=0‒−20.89%,t=−22.233,P<0.001),quinolones(APC=−9.74%,95%CI=0‒−18.53%,t=−7.652,P=0.002),macrolides(APC=−17.52%,95%CI=0‒−17.52%,t=−3.626,P=0.022)and lincoamides(APC=−49.01%,95%CI=0‒−74%,t=−3.35,P=0.029)showed a decreasing trend across the years.There were differences in the distribution of drug use reasons(χ^(2)=9458.427,P<0.001),as well as the age(χ^(2)=5421.709,P<0.001)and sex(χ^(2)=245.322,P<0.001)of patients.During the observation period,50.69%of antibiotic prescriptions were used to treat respiratory diseases,with the highest proportion of 57.67%in 2015 and the lowest proportion of 34.93%in 2020.58.37%of patients were aged 50‒70 years,with a decreasing proportion of patients under 50 years(17.83%in 2015,6.64%in 2020)and an increasing proportion of patients over 70 years(24.1%in 2015,38.41%in 2020).[Conclusion]The utilization rate of antibiotics used in outpatients from primary public medical institutions in a county of Zhejiang Province shows a decreasing trend across the years,but higher than that of secondary and above hospitals in China,and also higher than that of primary medical institutions in economically-developed areas.The management and monitoring of the clinical use of antibiotics in the county should be actively strengthened.