药品集中带量采购后某院抗菌药物使用及细菌耐药率变迁情况  

Antibacterial drug use and drug resistance rate in a hospital after drug centralized volume-based procurement

作　　者：向左娟 陈小娟 胡晓杰 谷秀梅 付滢舟 XIANG Zuo-juan;CHEN Xiao-juan;HU Xiao-jie;GU Xiu-mei;FU Ying-zhou(Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University,Changsha 410013)

机构地区：[1]湖南省肿瘤医院/中南大学湘雅医学院附属肿瘤医院,长沙410013

出　　处：《中南药学》2022年第11期2678-2683,共6页Central South Pharmacy

基　　金：湖南省自然科学基金-科卫联合项目(No.2018JJ6031)。

摘　　要：目的 探讨抗菌药物专项集中带量采购对临床选用药物及细菌耐药情况的影响,促进合理用药。方法 调取某院2017年5月—2022年4月抗菌药物消耗的品种及数量,其中2020年5月—2022年4月为专项集采执行期,收集病原菌检出情况和耐药数据,采用t检验比较专项集采执行前后的耐药率,Pearson法分析药物使用强度和耐药率之间的相关性。结果 专项集采执行后,喹诺酮类、一代头孢菌素使用强度降低超过0.5 DDDs,而β-内酰胺类/β-内酰胺酶抑制剂复方制剂(BL/BLIs)、三代头孢菌素升高超过0.5 DDDs。头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、氨苄西林/舒巴坦、头孢他啶、头孢曲松对大肠埃希菌及肺炎克雷伯菌的耐药率升高,左氧氟沙星则对肺炎克雷伯菌和金黄色葡萄球菌的耐药率降低(P<0.05)。相关性分析显示多个BL/BLIs和三代头孢菌素耐药率与这两类药物及碳青霉烯类使用强度成正相关。结论 医疗机构应密切关注药品集采过程中临床用药习惯的改变和耐药率的变迁,及时调整抗菌药物管理办法,促进合理用药,延缓耐药发生。Objective To determine the influence of special centralized volume-based procurement of antibacterial drugs on clinical drug selection and drug resistance and promote rational drug use.Methods The types and quantity of antibacterial drugs from May 2017 to April 2022 were retrospectively analyzed.May 2020 to April 2022 were the implementation periods of special centralized volume-based procurement of antibacterial drugs.Bacterial drug resistance data of pathogens during the same period were collected.t test was used to compare the drug resistance rates before and after the special centralized procurement.Pearson method was used to analyze the correlation between density of antibiotics use and resistance rate.Results After the implementation of special centralized volume-based procurement of antibacterial drugs,the density of antibiotics use decreased by more than 0.5 DDDs for quinolones and first-generation cephalosporins,while that increased by more than 0.5 DDDs for BL/BLIs and third-generation cephalosporins.The drug resistance rates of cefoperazone/sulbactam,piperacillin/tazobactam,ampicillin/sulbactam,ceftazidime and ceftriaxone to Escherichia coli and Klebsiella pneumoniae increased,while the drug resistance rates of levofloxacin to Klebsiella pneumoniae and Staphylococcus aureus decreased (P<0.05).The drug resistance rates of several BL/BLIs and third-generation cephalosporins were positively correlated with the density of use of both drugs and carbapenems.Conclusion Medical institutions should pay close attention to the change of clinical medication habits and drug resistance rates during the implementation of centralized volume-based procurement,timely adjust antimicrobial management methods,and promote rational drug use.

关 键 词：药品集中带量采购 耐药性 抗菌药物 使用强度 合理用药 

分 类 号：R95[医药卫生—药学]