台灣某地區教學醫院預防性抗生素之使用評估

Evaluation of Prophylaxis Antibiotics Usage at the District Teaching Hospital in Taiwan

李英鶴(Ying-Ho Lee)

指導教授 ： 楊世群

高雄醫學大學/藥學院/藥學研究所碩士在職專班/碩士(2010年)

摘要

摘 要
背景：抗生素普遍使用所引發的抗藥性問題，已迫使各國政府必須進行各種政策介入，包括手術病患預防性抗生素的使用，以及作為官方評鑑醫療照護品質的指標。正確的給予預防性抗生素，可以有效地降低手術後傷口感染率，有助於降低醫學中心與區域醫院手術病患的抗生素使用量。但卻少有研究論及地區教學醫院使用術前預防性抗生素的效益。
目的：本研究為評估台灣某地區教學醫院實施手術前預防性抗生素前後的效益，進行傷口感染率及醫療費用之分析比較。
方法：回溯分析2006年1月1日至2009年12月31日共四年的病歷內容、健保申報資料及感染報表，統計項目包括：患者基本資料、住院天數、感染案例、住院期間手術類別及各項住院費用。由病歷資料篩選出接受手術並合乎第一類手術傷口的患者，總計2137位，其中2006年為未實施前有448位，實施後2007年有447位，2008年有600位，2009年有642位，共計1,689位列入本研究，患者在手術前30分鐘給予單一劑量靜脈注射頭孢菌素類抗生素cefazolin。具有第I類外科手術部位傷口的患者，不論男女均列入研究。排除條件為具有第 II~IV類外科手術部位傷口的患者。
結果：研究發現2006年外科手術病人未施用術前預防性抗生素之手術部位感染率為1.3%，而2007-2009年已施用術前預防性抗生素者之感染率則分別為0.5% (2007)、2.0% (2008）、0.6% (2009），實施後之每年平均感染率為1.0 %。在2007-2009年已施用術前預防性抗生素的醫療費用、藥費及抗生素費，2007年每人平均分別為35,339元、4,548元、3,043元，2008年為157,694元、28,339元、18,481元，2009年則為129,093元、15,360元、10,401元。雖未達統計學顯著意義，但相較於實施前控制組感染醫療費用、藥費、抗生素費（2006年為202,932元、39,717元、22,706元）則皆有降低。而由2006-2009年術後感染費用分析發現，實施後醫療費用支出降低47.1％，藥費降低59.5%，抗生素費降低53.1％。此結果可做為術前預防性抗生素效益評估的依據及外科手術感染控制的參考。
關鍵字：預防性抗生素、手術部位感染、醫療費用

關鍵字

預防性抗生素 ； 手術部位感染 ； 醫療費用

並列摘要

ABSTRACT
Background: The prevalence of antibiotic resistance has compelled governments around the world to adopt policy interventions to improve antibiotic use, including establishing guidelines for the use of prophylactic antibiotics in surgical patients and making it an indicator in the assessment of quality of care. Proper use of prophylactic antibiotics can effectively decrease the rate of post-operative wound infection and has been known to help cut down the use of antibiotics for surgical patients in medical centers and regional hospitals. However, few studies examine the benefits of antibiotic prophylaxis in district teaching hospitals.
Purpose: This study evaluates the efficacy of pre-operative antibiotic prophylaxis and makes comparative analysis of wound infection rates and medical costs before and after the implementation of pre-operative antibiotic prophylaxis at the district teaching hospital.
Materials and Methods: Retrospective analysis of the medical records, national health insurance claim records and infection reports of the district teaching hospital from January 1, 2006 to December 31, 2009 was carried out. Information retrieved for analysis included: basic patient information, length of hospital stay, infection cases, types of operations received during hospitalization, and medical costs. A total of 2,137 patients with Type I surgical wound were selected, including 448 in 2006 who did not receive pre-operative antibiotic prophylaxis, and 447 in 2007, 600 in 2008 and 642 in 2009 (1,689 in total) who received pre-operative antibiotic prophylaxis. Patients who received pre-operative antibiotic prophylaxis were given a single dose of intravenous cefazolin 30 minutes before operation. All patients with Type I surgical wound, regardless of gender, were included in the study. The exclusion criteria were patients with Type II, III, or IV surgical wound.
Results: It is found that surgical patients in 2006 who did not receive pre-operative prophylactic antibiotics had surgical site infection rate of 1.3%, while the infection rates of patients in 2007 ~ 2009 who received pre-operative prophylactic antibiotics were respectively 0.5% (2007), 2.0% (2008) and 0.6% (2009), averaging 1.0% per year. The medical expenses, drug expenses, and antibiotics expenses incurred by patients in pre-operative prophylaxis group averaged $35,339, $4,548, and $3,043 in 2007, $157,694, $28,339, and $18,481 in 2008, and $129,093, $15,360, and $10,401 in 2009. Although those figures do not show statistically significant difference with the medical expenses, drug expenses, and antibiotics expenses of patients in the 2006 control group ($202,932, $39,717, and $22,706 respectively), the expenses did show a decline. An analysis of the grand total expenses of infection prevention after operation from 2006 to 2009 shows that total, drug and antibiotic expenses were reduced by 47.1%, 59.5%, and 53.1%, respectively, after the implementation of pre-operative antibiotic prophylaxis. The findings in this study could provide more evidence on the benefit of pre-operative antibiotic prophylaxis and surgical site infection control.

Keywords: surgical antibiotic prophylaxis, surgical site infection, medical cost

並列關鍵字

surgical antibiotic prophylaxis ； surgical site infection ； medical cost

參考文獻

參考文獻

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