- 學位論文
利用每日定義劑量測量抗感染藥物的使用與住院品質指標相關性之研究
Corrections between Anti-Infective Utilization as Measured by Defined Daily Dose and Quality Indicators in a Hospital
摘要
研究目的: 本研究評估某區域教學醫院2004至2008年的抗感染藥物的使用與醫院品質指標包括每千人日院內感染密度、出院平均住院日數、淨死亡率及粗死亡率的相關性研究。 研究設計：回溯性橫斷式研究。 研究單位：具有320床急性病床某區域教學醫院。 研究方法：抗感染藥物使用量統計是根據2008年6月WHO所公告的每日定義劑量(DDD)，利用DDD方法統計2004-2008年某區域教學醫院有關病房抗感染藥品使用，按WHO/ATC藥理分類，採用每百人日DDD數進行趨勢分析，並與醫院品質指標包括每千人日院內感染密度、出院平均住院日數、淨死亡率及粗死亡率探討其相關性的情形。 研究結果: 5年中抗感染藥物每百人日DDD數以J01D Cephalosporins最高，其次是J01C Penicillins，其它依序為J01G Aminoglycosid、J01M Quinolones、J01F Macrolides, Lincosamides and Streptogramins、J01X Other antibacterials、J04A Anti-tuberculosis。在醫院品質指標與抗感染藥物類別之每百人日DDD數相關性探討，具顯著意義者（p<0.05）有：1.與每千人日院內感染率相關包括J01CG Beta-lactamase inhibitors、J01DE Fourth-generation cephalosporins、J01XA Glycopeptide antibacter-ials 、J04AB Antibiotics、J04AC Hydrazides、J04AK Other drugs for treatment of tuberculosis。2.與出院平均住院日數相關包括J01DE Fourth-generation cephalosporins、J01FA Macrolidess、J01XC Steroid antibacterials。3.與淨死亡率相關為J01FA Macrolidess。4.與粗死亡率相關（p<0.05）為J01XA Glycopeptide antibacterials。 結論: 利用每日定義劑量測量抗感染藥物的使用密度可了解藥物使用趨勢，而我們將其結合醫院住院品質指標作相關性的分析研究，所得結果顯示J01CG Beta-lactamase inhibitors、J01DE Fourth-generation cephalosporins、J01XA Glycopeptide antibacterials 、J04AB Antibiotics、J04AC Hydrazides、J04AK Other drugs for treatment of tuberculosis、J01FA Macrolidess及J01XC Steroid antibacterials的抗感染藥物與醫院住院品質指標具有顯著性的相關性，這些相關性與文獻研究相吻合，藉由這些相關性可以指導訂定合理使用抗感染藥物管控措施，應可有效地促進醫院住院品質的改善。
並列摘要
Study Objective: To investigate relations between the use of anti-infectives and quality indicators of hospitalization, including nosocomial infection density, average length of stay, net and gross mortality rate in a regional teaching hospital in Taiwan during the period 2004 to 2008. Design: Retrospective cross-sectional study. Setting: A 320-bed regional teaching hospital in Taiwan. Methods: The DDD of use of anti-infectives was analyzed in wards in a regional teaching hospital during the period 2004 to 2008. The DDD was based on that defined by the WHO in June 2008. According to WHO/ATC classification of pharmacology, tendency of use of anti-infectives are expressed as DDD and DDD/100 patient-days. This study investigated relations between DDD of use of anti-infectives and indicators of quality of hospitalization, including nosocomial infection density, average length of stay, net mortality rate, and gross mortality rate. Results: Results showed that J01D cephalosporins had the highest use density over the 5-year period, followed by J01C penicillins; J01G aminoglycoside; J01M quinolone; J01F macrolides, lincosamides and streptogramins; J01X Other antibacterials and J04 anti-tuberculosis. These results indicate DDD/100 patient-days of various categories of anti-infectives significantly (p<0.05) associated with quality indicators of hospitalization contained: 1. Nosocomial infection density included J01CG beta-lactamase inhibitors; J01DE fourth-generation cephalosporins; J01XA glycopeptide antibacterials; J04AB antibiotics; J04AC hydrazides and J04AK other drugs for treatment of tuberculosis. 2. Average length of stay included J01DE fourth-generation cephalosporins; J01FA macrolides and J01XC steroid antibacterials. 3. Net mortality included J01FA macroides. 4. Gross mortality included J01XA glycopeptide antibacterials. Conclusion: The use of DDD to measure the use density of anti-infectives can aid in the understanding of tendencies for drug use. We analyzed relations between DDD and hospitalization quality indicators, and our results J01CG Beta-lactamase inhibitors; J01DE Fourth-generation cephalosporins; J01XA Glycopeptide antibacterials; J04AB Antibiotics; J04AC Hydrazides; J04AK Other drugs for treatment of tuberculosis; J01FA Macrolidess and J01XC Steroid antibacterials that were significantly associated with quality indicators of hospitalization. Our results these findings are consistent with those of previous reports and can be a reference for establishing rational measures to control anti-infective drug use in order to effectively improve hospitalization quality.