碳青霉烯类抗菌药物及替加环素的临床应用管理及成效分析

目的 加强对南阳市第一人民医院碳青霉烯类抗菌药物及替加环素的临床应用管理，分析评价其管理成效。方法 分析2016年1月1日-2018年6月30日医院对碳青霉烯类抗菌药物及替加环素使用管理前后出院患者抗菌药物使用率、患者平均住院日、人均抗菌药物费用、所占费用比例、各品种销售金额比例和微生物送检率等的变化情况。结果 加强管理前后总抗菌药物使用率和碳青霉烯类药物使用率分别由54.12%，1.69%明显降至50.44%，1.30%（P<0.05）；加强管理后患者人均抗菌药物费用为1 095.75元，较加强管理前的1 190.83元有明显下降（P<0.05）；碳青霉烯类及替加环素费用占总药品费用和总治疗费用比例分别由加强管理前的2.09%，0.84%降至1.81%，0.66%（P<0.05）；加强管理后总治疗性抗菌药物、特殊使用级抗菌药物、碳青霉烯类及替加环素微生物送检率由管理前的32.03%，81.34%和85.31%分别提高至36.17%，85.99%和92.95%（P<0.05）。结论 通过对碳青霉烯类抗菌药物及替加环素使用的综合干预措施可显著降低此类药物的使用率和人均抗菌药物费用，有效提高微生物标本送检率，且平均住院日无明显变化。

Clinical Management and Effectiveness Analysis of Carbapenem Antibiotics and Tigecycline

OBJECTIVE To strengthen the management of the clinical utilization of carbapenems antibiotics and tigecycline in Nanyang First People''s Hospital, analyze and evaluate its management effectiveness. METHODS The antibiotics usage rate, the mean hospital stay, the mean cost of antibiotics, the proportion of expenses, the proportion of sales of various varieties, and submission rates of microbiological specimen of the patients who were treated with carbapenems and tigecycline before and after the administration in our hospital between January 1, 2016 and June 30, 2018 were retrospectively analyzed. RESULTS The median usage rate of total antimicrobial agents and carbapenems before and after administration were significantly decreased from 54.12% and 1.69% to 50.44% and 1.30%, respectively(P<0.05). After strengthening the management, the median cosy of antibiotics per patient was 1 095.75 yuan, which was lower than the 1 190.83 yuan before the strengthening of management(P<0.05). The cost of carbapenems and tigecycline as a proportion of total drug cost and total treatment costs before and after administration were significantly decreased from 2.09%, 0.84% to 1.81%, 0.66%, respectively(P<0.05). The submission rates of microbiological specimens efore general, special therapeutic antimicrobial use, carbapenems and tigecycline increased from 32.03%, 81.34% and 85.31% of pre-intervention respectively to 36.17%, 85.99% and 92.95% of postintervrntion respectively(P<0.05). CONCLUSION Comprehensive intervention measures of carbapenems and tigecycline can significantly reduce the use rate of these drugs and the mean cost of antibacterial agents, improve the submission rates of microbiological specimens before therapeutic use of antimicrobial agents, and there is no significant change in average hospital stay.