JCI认证前后氟喹诺酮类药物利用调查

Drug Utilization Study of Fluoroquinolones Before and After JCI Accreditation

关键词:  氟喹诺酮类  耐药性  革兰氏阴性菌  使用强度  药物利用  合理用药

Key words:  fluoroquinolones  antimicrobial resistance  Gram-negative bacteria  use intensity  drug utilization  rational drug use

摘要:

目的 了解在抗菌药物整治活动和国际医疗卫生机构认证标准(JCI)认证前后医院内氟喹诺酮类用药合理性的改善情况。方法 回顾性调查2009—2013年鲍曼不动杆菌(Ab)、铜绿假单胞菌(Pa)、肺炎克雷伯菌(Kp)和大肠埃希菌(Ec)的耐药率和抗菌药物使用强度，以及住院患者左氧氟沙星的用药合理性及氟喹诺酮类的用药差错。结果 抗革兰氏阴性细菌药物使用强度呈下降趋势。Ab、Kp、Ec对环丙沙星和左氧氟沙星耐药率、Pa对左氧氟沙星的耐药率均持续下降。氟喹诺酮类的使用强度逐年下降，与4种细菌对环丙沙星、左氧氟沙星、哌拉西林钠他唑巴坦钠的耐药率、Pa对头孢他啶、头孢吡肟、亚胺培南和美罗培南的耐药率显著正相关。与左氧氟沙星和莫西沙星不同的是，环丙沙星使用强度与细菌耐药性相关性不强。左氧氟沙星静脉给药与口服使用量的比值显著降低(P<0.05)，基于肌酐清除率设计剂量的病历占比明显增加(P<0.05)。97.2%的氟喹诺酮类用药差错被药师前瞻性有效拦截。结论 氟喹诺酮类抗菌药的用药规范性和合理性有明显提升。氟喹诺酮类与其他抗菌药在细菌耐药性方面的影响存在复杂的关系。控制氟喹诺酮类抗菌药的过度使用，可积极影响细菌对其他抗菌药的耐药性，但不同氟喹诺酮类药物对细菌耐药性的影响存在差异。

Abstract:

OBJECTIVE To learn the changes in rationality of fluoroquinolones use during the national program of antibiotics stewardship and Joint Commission International accreditation. METHODS The retrospective analysis was performed on antibacterial use and bacterial resistance rate of acinetobacter baumanii(Ab), pseudomonas aeruginosa(Pa), Klebsiella pneumonia(Kp) and Escherichia coli(Ec), appropriateness of levofloxacin use in inpatients and fluoroquinolones- related medication errors during 2009-2013. RESULTS Decreasing trend was observed in the use intensity of anti-Gram- negative bacteria agents. The continuous decrease in resistance rate was observed with Ab, Kp and Ec against ciprofloxacin and levofloxacin, and Pa against levofloxacin. The use intensity of fluoroquinolones decreased year by year and it was positively correlated with resistance rate of four bacterial against ciprofloxacin, levofloxacin, piperacillin sodium/tazobactam sodium, Pa against ceftazidime, cefepime, imipenem and meropenem. Compared with levofloxacin and moxifloxacin, ciprofloxacin exhibited little correlation between its use intensity and bacterial resistance rate. The ratio of intravenous route to oral route of levofloxacin decreased significantly(P<0.05) and dose adjustment based on creatinine clearance rate increased significantly(P<0.05). The 97.2% of fluoroquinolones-related medication errors were efficiently intercepted by auditing pharmacists. CONCLUSION The rationality of fluoroquinolones clinical use improves significantly. Fluoroquinolones have complicated relationships with other antibacterials with respect to bacterial resistance. Control of overusing fluoroquinolones may positively affect the bacterial resistance of other antibacterials. However, different fluoroquinolones may have different influences on the bacterial resistance.