摘要
目的:考察专档管理后阜阳市第二人民医院(以下简称“我院”)碳青霉烯类抗菌药物用药频度(defined daily dose system,DDDs)和2次干预后合理性评价指标的变化趋势,为我院碳青霉稀类药物的合理应用提供科学管理依据。方法:从我院美康临床药学管理系统和医院信息系统中调取专档管理前(2016年)、管理后(2017—2019年)碳青霉烯类抗菌药物的销售数据;再随机抽取2018年8—9月、2019年8—9月2个时间段内使用碳青霉稀类抗菌药物的病历各80份,依次作为第1次干预组、第2次干预组,比较专档管理前后碳青霉烯类抗菌药物的DDDs以及2次干预后用药指征、联合用药、降钙素原检测及病原微生物送检等指标合理性。结果:我院碳青霉烯类抗菌药物的销售金额由2016年221.43万元逐年增至2018年307.57万元,随后显著降至2019年202.93万元;碳青霉烯类抗菌药物销售金额占抗菌药物总销售金额的比例由2016年的17.14%显著降至2019年的6.23%;碳青霉烯类抗菌药物的累积DDDs占抗菌药物累积DDDs的比例由2016年的5.39%缓慢增至2017年的5.80%,随后显著降至2019年的3.38%。第2次干预组用药指征适宜患者所占比例由第1次干预组的53.75%升至72.50%,药物选择适宜患者所占比例由第1次干预组的68.75%显著升至85.00%,降钙素原检测、病原微生物送检和特殊使用级抗菌药物病程记录患者所占比例分别由第1次干预组的52.50%、66.25%和66.25%显著升至73.75%、88.75%和83.75%,上述差异均有统计学意义(P<0.05)。第1、2次干预组在用法及用量适宜性、溶剂选择适宜性和溶剂剂量适宜性等方面的差异均无统计学意义(P>0.05)。结论:碳青霉烯类抗菌药物专档管理对DDDs、销售金额和销售量有动态降低趋势,第2次干预后合理评价指标尤其是用药指征适宜性、药物选择适宜性等较第1次干预后显著改善,但用药指征的把握仍有待提高。为避免碳青霉稀类抗菌药物应用指征不严甚至滥用所致革兰阴性菌杆菌耐药性升高,今后仍需加强严格掌握碳青霉稀类抗菌药物临床应用适应证的管理力度。
OBJECTIVE:To investigate the change trend of defined daily dose system(DDDs)of arbapenem antibiotics after special management and rationality evaluation index after twice of interventions in Fuyang the Second People's Hospital(hereinafter referred to as“our hospital”),so as to provide scientific management basis for the rational application of carbapenems antibiotics in our hospital.METHODS:The sales data of carbapenem antibiotics before(2016)and after special management(from 2017 to 2019)from the special medical management system and the hospital information system in our hospital were collected.Totally 80 medical records of carbapenem antibiotics were randomly selected from Aug.to Sept.in 2018 and Aug.to Sept.in 2019,respectively,which were divided into the first intervention group and the second intervention group.Compare the rationality of carbapenem antibiotics DDDs before and after special management,and the indications of drug use,combined use,procalcitonin detection,and pathogen microbial submission after 2 interventions.RESULTS:The consumption sum of carbapenem antibiotics in our hospital increased from 2214300 yuan in 2016 to 3075700 yuan in 2018,and then decreased significantly to 2029300 yuan in 2019.The proportion of consumption sum of carbapenem antibiotics to total consumption sum of antibiotics decreased significantly from 17.14%in 2016 to 6.23%in 2019.The proportion of cumulative DDDs of carbapenem antibiotics to cumulative DDDs of antibiotics increased slowly from 5.39%in 2016 to 5.80%in 2017,and then decreased significantly to 3.38%in 2019.The proportion of patients with appropriate drug indications increased from 53.75%in the first intervention group to 72.50%in the second intervention group,and the proportion of patients with proper drug selection increased significantly from 68.75%in the first intervention group to 85.00%in the second intervention group,the proportion of patients with records of procalcitonin detection,pathogen microbial examination and special application grade antibiotics increased from 52.50%,66.25%and 66.25%in the first intervention group to 73.75%,88.75%and 83.75%in the second intervention group,the differences were statistically significant(P<0.05).There was no statistically significant difference in the suitability of usage and dosage,solvent selection and solvent dose between the first and second intervention groups(P>0.05).CONCLUSIONS:The specialized management of carbapenem antibiotics has dynamic trend of decreasing DDDs,consumption sum and consumption amount.The rational evaluation indexes after the second intervention,especially the suitability of drug indications and drug selection,were significantly improved compared with those after the first intervention,but the grasp of drug indications still needs to be improved.In order to avoid the increase of drug resistance of gram-negative bacteria caused by improper indications and abuse of carbapenem antibiotics,it is still necessary to strengthen the management of indications for clinical application of carbapenem antibiotics.
作者
张瑞
韩明锋
腾小宝
毛新妍
ZHANG Rui;HAN Mingfeng;TENG Xiaobao;MAO Xinyan(Dept.of Pharmacy, Fuyang the Second People's Hospital, Anhui Fuyang 236015, China;Dept.of Respiratory and Critical Care Medicine, Fuyang the Second People's Hospital, Anhui Fuyang 236015, China)
出处
《中国医院用药评价与分析》
2020年第5期636-640,共5页
Evaluation and Analysis of Drug-use in Hospitals of China
关键词
碳青霉稀类抗菌药物
销售金额
用药频度
专档管理
干预措施
Carbapenem antibiotics
Consumption sum
Defined daily dose system
Specialized management
Intervention
