2015至2021年上海市社区卫生服务中心大环内酯类药物使用情况分析

Analysis of macrolides use in community health service centers in Shanghai from 2015 to 2021

目的 对上海市社区卫生服务中心大环内酯类使用情况予以详细分析,为社区卫生服务中心制定相关管理制度和措施提供实证依据。方法 采用回顾性调查法对2015至2021年上海市社区抗菌药物临床应用监测网中大环内酯类品种数、门诊和住院各种大环内酯类抗菌药物DDDs使用数据进行分析。结果 2015至2021年,在纳入调查的社区卫生服务中心中,大环内酯类品种数稳定在7~8种,总体DDDs由第3位降至第4位,大环内酯类DDDs占所有抗菌药物DDDs的比例呈现逐年下降趋势,其中门诊自2015年的17.49%逐渐降低至2021年的10.82%,而住院自2015年12.05%逐渐降低至2021年的3.77%。大环内酯类住院的平均DDDs自2017年呈现逐渐降低趋势,自568.70逐渐降低至2021年的93.91;大环内酯类门诊的平均DDDs自2015年的31 286.19逐渐降低至2021年的10 624.46。剂型方面,大环内酯类口服制剂DDDs比例由2015年的93.88%上升至2021年的98.82%;2015至2021年上海社区卫生服务中心关于大环内酯类在品种使用方面的DDDs,以阿奇霉素、红霉素、罗红霉素和克拉霉素口服制剂和阿奇霉素注射剂为主。2015至2021年红霉素、罗红霉素和克拉霉素口服制剂及阿奇霉素注射剂等为主的大环内酯类药物品种DDDs呈逐年下降趋势,但2015至2021年上海社区服务中心关于阿奇霉素口服制剂DDDs反而呈上升趋势,与其他大环内酯类药物品种的DDDs情况反差较大。上海市细菌真菌耐药监测网数据显示,2015至2021年耐甲氧西林金黄色葡萄球菌(MRSA)、肺炎链球菌、草绿色链球菌和β溶血性链球菌对红霉素的耐药率>50%,以肺炎链球菌最高;阿奇霉素对流感嗜血杆菌的敏感率较好,但也呈现逐年下降趋势。2015至2021年大环内酯类不合理用药情况呈逐年下降趋势,其中用法/用量不当、药物选择不当降低趋势最为显著。用法/用量不当自2015年的17.00%降低至2021年的5.47%,药物选择不当自2015年的11.37%降低至2021年的6.08%。2015至2021年大环内酯类药物使用均无超说明书使用现象。结论 社区卫生服务中心大环内酯类使用频度呈现逐年下降趋势,但还是存在品种集中度高的问题,对相关致病菌耐药性的影响应给予重视。

Objective To provide a detailed analysis of the use of macrolides in community health service centers in Shanghai,and to provide empirical evidence for the development of relevant management systems and measures in community health service centers.Methods A retrospective survey was conducted to analyze the number of macrolides and defined daily doses(DDDs)of macrolides in outpatient and inpatient settings from the Shanghai Community Antibiotics Clinical Application Monitoring Network from 2015 to 2021.Results Among the community health service centers included in the survey,7-8 types of macrolides were stably used,with the overall DDDs decreased from the 3rd to 4th from 2015 to 2021.The proportion of macrolide DDDs in all antimicrobial DDDs showed a decreasing trend year by year,showing a decrease from 17.49%in 2015 to 10.82%in 2021 in outpatient settings,and a decrease from 12.05%in 2015 to 3.77%in 2021 in inpatient settings.The average of macrolide DDDs in the hospitalization gradually decreased from 568.70 in 2017 to 93.91 in 2021.The average of macrolide DDDs in outpatient settings gradually decreased from 31286.19 in 2015 to 10624.46 in 2021.In terms of dosage form,the proportion of oral macrolide DDDs increased from 93.88%in 2015 to 98.82%in 2021.From 2015 to 2021,azithromycin,erythromycin,roxithromycin,clarithromycin oral preparations,and azithromycin injections were the dominant macrolides in Community Health Service Centers in Shanghai.From 2015 to 2021,the DDDs of macrolide drugs,mainly erythromycin,roxithromycin,clarithromycin oral preparations,and azithromycin injections,showed a decreasing trend year by year.However,from 2015 to 2021,the DDDs of oral azithromycin preparations showed an upward trend,showing a stark contrast to the DDDs of other macrolide drugs.According to data from the Shanghai Bacterial and Fungal Drug Resistance Monitoring Network,from 2015 to 2021,methicillin-resistant Staphylococcus aureus(MRSA),Streptococcus pneumoniae,Streptococcus aeruginosa,andβ-hemolytic streptococcus had an average resistance rate to erythromycin at 50%and higher,with Streptococcus pneumoniae on the top.Azithromycin was sensitive to Haemophilus influenzae,but it also showed a decreasing trend year by year.The irrational use of macrolides has been decreasing year by year from 2015 to 2021,with the most significant decreasing trend observed in improper usage/dosage and drug selection.Improper usage/dosage rate decreased from 17.00%in 2015 to 5.47%in 2021,and improper drug selection rate decreased from 11.37%in 2015 to 6.08%in 2021.From 2015 to 2021,the use of macrolide drugs did not exceed the instructions.Conclusion The frequency of macrolide use in community health service centers in Shanghai annually decreases,but concentratedly used.The drug resistance should be concerned.