醫學中心及區域醫院手術預防性抗生素2000年至2004年監測結果之分析

Surgical Prophylactic Antibiotic Usage in Medical Centers and Regional Hospitals in Taiwan: 2000 to 2004

張上淳(Shan-Chwen Chang) ； 陳主慈(Chu-Tzu Chen) ； 林安麗(An-Li Lin) ； 陳垚生(Yao-Shen Chen) ； 張峰義(Feng-Yee Chang) ； 周明淵(Ming-Yuan Chou) ； 陳宜君(Yee-Chun Chen) ； 柯文謙(Wen-Chien Ko) ； 莊銀清(Yin-Ching Chuang) ； 呂學重(Hsieh-Shong Leu) ； 劉永慶(Yu)

《感染控制雜誌》 16卷3期 (2006/06) Pp. 137-152

https://doi.org/10.6526/ICJ.200606_16(3).0001

摘要

經由健保局2000年1月1日至2004年6月30日申報資料的分析，針對單純性疝氣手術（住院手術者）、單純性疝氣手術（門診手術者）、甲狀腺切除術、人工髖關節置換術、人工膝關節置換術、冠狀動脈繞道手術、全乳房切除術（無合併症者）、全乳房切除術（有合併症者）、以及剖腹產等九種手術類型個案之抗生素使用情形進行監測分析，結果除了人工髖關節、膝關節置換術及冠狀動脈繞道手術維持100%或將近100%之個案使用抗生素外，其他各種手術個案之抗生素使用百分比都有逐漸下降之情形，且不論是醫學中心或區域醫院都有相同的趨勢，但整體而言，區域醫院使用抗生素的比例較醫學中心為高。不論是醫學中心或區域醫院所執行之各類手術平均每一個案之抗生素花費，在監測期間也都有明顯的下降，醫學中心之各類手術個案平均抗生素花費下降17.2%-53.3%，區域醫院則下降14.1%-53.5%；除了單純性疝氣手術門診手術個案及冠狀動脈繞道手術外，其他七類手術之平均抗生素花費都是以區域醫院花費較高。至於使用抗生素的種類，整體而言，單用口服cephalosporin的百分比、使用注射合併口服cephalosporin者的百分比、以及併用aminoglycoside者的百分比均逐年下降；而單用注射cephalosporin者之百分比逐漸上升，在醫學中心之各類手術個案單用注射cephalosporin之百分比均大約可達30%以上。由此監測結果，可見台灣醫學中心及區域醫院執行上述手術使用抗生素之合理性有逐漸緩慢的改善，然而距離一般手術預防性生素使用指引之建議，仍有相當大可以改善的穿間，仍然需要更多的努力。

關鍵字

抗生素 ； 醫學中心 ； 區域醫院 ； 手術

並列摘要

The claimed expenditure for antibiotic usage to the National Health Insurance Bureau by medical centers (those hospitals with bed numbers beyond 800 and was accredited to be teaching hospitals) and regional hospitals (those with bed numbers between 250-800) in Taiwan during January 1, 2000 to June 30, 2004, for nine surgical procedures were monitored and analyzed. These include simple herniorrhaphy with hospitalization, simple herniorrhaphy with-out hospitalization, thyroidectomy, total hip replacement (THR), total knee replacement (TKR), coronary artery bypass graft surgery (CABG), total mastectomy without complication, total mastectomy with complication, and Caesarian section. The analysis was carried out for the data over the nine half-a-year periods. The results indicated that except for patients who had THR, TKR and CABG (100% or almost 100% of them received prophylactic antibiotics), the proportion of patients given antibiotics decreased gradually in all other surgeries, in both medical centers and regional hospitals. In general, there were higher proportions of patients given the prophylactic antibiotics in regional hospitals, compared to medical centers. The average cost of antibiotics per patient among those who received them decreased gradually for all surgeries during the study period. In medicals centers, the average cost of antibiotics per patient decreased 17.2%-53.3%. In regional hospitals, it declined by 14.1%-53.5%. Except for simple herniorrhaphy without hospitalization and CABG, the average cost of the antibiotics per patient in other seven kinds of surgery was higher in regional hospitals than in medical centers. During the study period, the proportion of patients prescribed with oral cephalosporins alone, intravenous (Ⅳ) followed by oral cephalosporins, and cephalosporin plus aminoglycosides decreased. And the proportion of patients prescribed with Ⅳ cephalosporin alone increased. These trends were the same either in medical centers or in regional hospitals. We conclude that the usage of surgical prophylactic antibiotics improved gradually during the past five years in medical centers and regional hospitals in Taiwan.

並列關鍵字

Antibiotics ； medical center ； regional hospital ； surgery