藥師評估介入後管制性抗生素使用之影響-以南部某地區醫院為例

背景：世界衛生組織 (WHO) 於2011年4月7日將「Combat drug resistance」訂為世界衛生日主題，強調「No action today, no cure tomorrow」，呼籲各國重視抗藥性議題。抗生素不合理使用、多重抗藥性細菌的衍生及新藥的研發趨緩，已使抗藥性成為全球公共衛生的重要疑慮，為減緩國內抗藥性的問題，醫院配合疾病管制署之抗生素合理使用及感染管制措施，自2014年起推動抗生素管理計畫 (Antibiotics Stewardship Program, ASP)。目的：了解藥師評估介入後醫院在管制性抗生素使用上更趨嚴謹合理，以減少抗藥性細菌發生，降低病人醫療照護相關感染風險，促進病人安全並提升醫療品質。研究對象：2013至2018使用管制性抗生素之住院病人歸戶去識別化資料進行描述性分析及多變項?A歸分析。結果與結論：藥師介入抗生素管制計畫之後，管制性抗生素處方評估率上升。每日劑量/千人日（DID)數值於近兩年呈現下降之趨勢。藥物利用指數（DUI)更趨近於1。具抗藥性的菌株數量比率下降（27.66％下降19.23％)，管制性抗生素藥費占率下降（94％下降76％)，根據本研究結果顯示其住院天數16.78天下降至13.90天，下降達2.88天，效果明顯，顯示ASP推行後成效良好。

關鍵字

藥師介入；管制性抗生素；藥物利用指數

並列摘要

Background: In seventh of April 2011, WHO has been decided “Combat drug resistance” as the topic of World Health Day of that year, stated “No action today, no cure tomorrow”, and call to whole world for the importance of drug resistance. Due to the unreasonable usage of antibiotics, derivative of multi-drug resistant bacteria and the slowdown of research of new drugs, all these issues have already caused drug resistance into a huge concern in the global public health issues. Centers for Disease Control has begun the Antibiotics Stewardship Program (ASP) in 2014 to alleviate the drug resistance problems in the country. Purpose: The purpose is to understand whether the hospital's physicians prescribe the controlled antibiotics more rigorously and reasonably after the pharmacist's intervention, to reach the goals of reasonable usage of antibiotics to reduce drug resistant bacteria occur, reduce chances of medical care related infection of patients, promote patients’ safety and improve medical quality. Methods: Inpatients using the controlled antibiotics from a southern hospital from 2013 to 2018. Using multivariate regression analysis to analyze these data. Results：After the intervention of pharmacists, the rate of controlled antibiotic prescription evaluation increased, DID (defined daily dose / 1000 patient-days) has shown a downward trend in the past two years, DUI (drug utilization index) was closer to 1, the number of resistant strains decreased (27.66% fell to 19.23%), and the medicine costs fell from 94% to 76%. Conclusions：According to the results of this study, the number of hospitalization days dropped from 16.78 days to 13.9 days, a decrease of 2.88 days. The effect is significant, showing that the ASP has achieved good results.

並列關鍵字

Pharmacists intervention ； Controlled antibiotics ； DUI

參考文獻

1. 葉碧玲, 南部某地區醫院門診抗生素使用評估, 高雄醫學大學藥學系碩士在職專班碩士論文, 2015. p. 1-72..

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