集中带量采购政策对注射用喹诺酮类药物处方行为和细菌耐药性影响分析  

Impact of centralized drug volume-based procurement policy on the prescribing behaviors and bacterial resistance of quinolone injection

作　　者：过佳月 刘金春 张海霞 陈大宇 GUO Jia-yue;LIU Jin-chun;ZHANG Hai-xia;CHEN Da-yu(Department of Pharmacy,Nanjing Drum Tower Hospital,School of Basic Medicine and Clinical Pharmacy,China Pharmaceutical University,Nanjing 210008;Department of Pharmacy,Nanjing Drum Tower Hospital,Nanjing 210008;Nanjing Center of Clinical Pharmacy,Nanjing Drum Tower Hospital,Nanjing 210008;School of Basic Medicine and Clinical Pharmacy,China Pharmaceutical University,Nanjing 210009)

机构地区：[1]中国药科大学基础医学与临床药学学院,南京鼓楼医院药学部,南京210008 [2]南京鼓楼医院药学部,南京210008 [3]南京鼓楼医院南京市临床药学中心,南京210008 [4]中国药科大学基础医学与临床药学学院,南京210009

出　　处：《中南药学》2024年第4期1080-1086,共7页Central South Pharmacy

基　　金：江苏省药学会恒瑞医院药学基金科研项目(No.H202106);南京临床医学中心建设项目(No.宁卫科教[2020]1号)。

摘　　要：目的 研究集中带量采购政策对注射用喹诺酮类药物使用情况的影响和细菌耐药情况的变化。方法 提取南京鼓楼医院2017年1月—2019年10月和2020年1月—2022年10月注射用喹诺酮类药物的使用数据,采用中断时间序列模型分析集采政策对其产生的影响;基于集采政策相关的调查问卷分析本院医务人员对政策的看法及产生相应行为的原因;利用相应时间段细菌耐药率、检出量进行相关性分析。结果 第三批集采政策实施后,莫西沙星使用量呈下降趋势;第五批集采政策实施后,莫西沙星和环丙沙星的使用量呈上升趋势,且相较于对照组变化存在显著性差异;左氧氟沙星使用量呈持续下降趋势。问卷调查显示,喹诺酮类药物作为替代药优先选择,与第五批集采后喹诺酮类药物使用量的上升一致。喹诺酮类药物耐药率受政策影响不明显,与喹诺酮类药物用量无高度相关性。结论 喹诺酮类药物在第三批集采政策实施后使用量下降,在第五批实施后也未出现异常增长现象。相关病原菌耐药率与药物使用量无高度相关性,政策对耐药率变化的影响还需长期监测。Objective To determine the effect of centralized drug volume-based procurement policy on the use of quinolone injection and changes in bacterial resistance.Methods Data of quinolone injection use in Nanjing Drum Tower Hospital from January 2017 to October 2019 and from January 2020 to October 2022 were collected.The impact of policy was analyzed with interruption time series model.The opinions of medical staff on centralized drug procurement and the reasons of corresponding behaviors were analyzed based on questionnaires.The correlation analysis was conducted with bacterial resistance rate and the detected quantity in corresponding time period.Results After the implementation of the policy for the third time,the use of moxifloxacin decreased.After the implementation of the policy for the fifth time,the use of moxifloxacin and ciprofloxacin began to increase,and there was a difference between the changes in the control group and the impact of the policy(P<0.05).In contrast,levofloxacin use continued to decline.The questionnaire showed that quinolones were preferred as alternative drugs,which was consistent with the rise in quinolones use after the fifth implementation.The resistance rate of quinolone drugs did not obviously increase due to policy influence,without clear correlation with the usage of quinolone drugs.Conclusion The usage of quinolone drugs decreases after the third implementation of the policy of centralized procurement and does not show abnormal growth after the fifth implementation.The resistance rates of relevant pathogens are not highly correlated with the drug usage.Long-term monitor of the impact of policies on the resistance rate is necessary.

关 键 词：集中带量采购政策 喹诺酮类药物 中断时间序列分析 耐药率 

分 类 号：R951[医药卫生—药学]