資訊系統於抗生素管理之角色與成效探討

Abstract

本研究針對某地區醫院於2016年1月所開始實施之「資訊系統輔助抗生素管理措施」並選取於實施前後同季各三個月期間(分別為〝基礎期〞-2015年1月到3月以及〝加強期〞-2016年1月至3月)抗生素藥費、住院抗生素用量、醫療照護相關感染細菌對藥物之敏感性趨勢的分析。 本研究共納入22,145住院人日數，其中基礎期有11,387住院人日數，於加強期有10,758住院人日數。 在抗生素藥費方面，減少187,802元；同時住院病人抗生素藥費占所有藥費的百分比也由27.73%減少至19.01%；而住院抗生素總量則是由藥劑部的藥物耗用紀錄，依定義每日劑量數(DDDs)概念分析。結果加強期較基礎期的住院抗生素總耗用量減少3839DDDs(5532vs.9371) ，約減少原耗用量的40.97%。 醫療照護相關感染密度無明顯改變。從臨床分離之醫療照護相關感染細菌對抗生素敏感性大多無明顯改變。 此經驗期能提供同儕醫院於發展抗生素管理計畫的參考，亦希望藉由本院持續落實資訊系統輔助抗生素管理，減少醫療資源浪費並增進病人安全。

The cost of antibiotics remains high for hospitals, and inappropriate antibiotic use may lead to increased resistance to antibiotics. In current stuies, patients admitted in the first quarter (January to March) of the year before and after implementation of the program were in cluded. The impacts of intensive antibiotic stewardship programs were analyzed by comparing indicators including related antibiotic costs, antibiotic consumptions and bacterial susceptibilities. Among the total of 22,145 hospitalized-days, the sample sizes for two periods (before and after the implemented programs) were similar (11,387 vs 10,758). The expenses incurred for antibiotics administered to hospital inpatients reduced from NT$517,974 (27.73% of the expenses on drugs administered to hospital inpatients) to NT$330,172 (19.01% of the expenses on drugs administered to hospital inpatients). Antibiotic consumption was also evaluated by collecting drug-users records obtained from the pharmacy according to the concept of the defined daily doses (DDDs). Consumption of antibiotics decreased by 40.97% (5532 vs 9371) compared to te basal study period. The overall incidence of healthcare-associated infection did not decline significantly. The susceptibilities of the bacterial organisms isolated from the patients of the healthcare-associated infections towards antibiotics did not decline significantly. Our experience could be a reference for developing individual antibiotic stewardship at peer hospital. We wish to reduce medical expenditure and improve patient safety by continued attainment of computer-assisted antimicrobial stewardship.