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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 曹承礎 | |
| dc.contributor.author | Huan-Po Lin | en |
| dc.contributor.author | 林煥博 | zh_TW |
| dc.date.accessioned | 2021-06-08T01:41:30Z | - |
| dc.date.copyright | 2016-08-25 | |
| dc.date.issued | 2016 | |
| dc.date.submitted | 2016-08-19 | |
| dc.identifier.citation | 一、中文部份
1.張上淳，陳美文，林美智，等人：台灣人用抗生素與動物用抗生素使用量之調查研究。感控雜誌 2003;13:334-45。 2.張進祿，張國寬，戴方楟：南部某區域醫院降低住院抗生素藥費之管理經驗。感控雜誌2009;20:79-90。 3.吳仁和、陳翰容等。醫療資訊管理，智勝出版，2013年。 4.張慧郎、邱文達等。醫學資訊管理學，華杏出版，2013年。 5.黃高彬：醫師應合 理且謹慎使用抗生素。醫療品質雜誌 2014；8:82-86。 6.陳玉瑩，邱政洵：善用打擊感染症的武器--感染管制的觀念。醫療品質雜誌2011； 5:54-57。 7.胡杏宜、徐育芝、顏永豐：抗生素管理對照護品質的影響。醫療品質雜誌 2013； 7:59-62。 8.林明鋒：從細菌的抗藥性談抗生素管理的重要性。感控雜誌 2012；22:115-123。 9.行政院衛生福利部疾病管制署。抗生素管理手冊，行政院衛生福利部疾病管制署出版， 2015年。 二、英文部份 1. Agwu AL, Lee CK, Jain SK, et al: A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center. Clin Infect Dis 2008;47:747-53. 2. Astagneau P, Brucker G: Organizations of hospital-acquired infection control in France. J Hosp Infect 2001;47:84-7. 3. Austin DJ, Kristinsson KG, Anderson RM: The relationship between the volume of antimicrobial consumption in human communities and the frequency of resistance. Proc Natl Acad Sci 1999;96:1152-6. 4. 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Am J Epidemiol 1985;121:182-205. 27. Heckerling PS, Canaris Gj, Flach SD, et al: Predictors of urinary tract infection based on artificial neural networks and genetic algorithms. Int J Med Inform 2007;76:289-96. 28. Hillestad R, Bigelow J, Bower A, et al: Can electronic medical record systems transform health care: Potential health benefits, savings, and costs. Health Aff (Millwood) 2005;24:1103-17. 29. Horan TC, Andrus M, Dudeck MA: CDC/NHSN surveillance definition of health careassociated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309-32. 30. Hsieh SH, Hsieh SL, Weng YC, et al: Middleware based Inpatient Healthcare Information System, in Bioinformatics and Bioengineering, 2007. BIBE 2007. Proceedings of the 7th IEEE 31. Huttner B, Goossens H, Verheij T, et al: Characteristics and outcomes of public campaigns aimed at improving the use of antibiotics in outpatients in high-income countries. Lancet Infect Dis 2010;10:17-31. 32. Jaggi N, Sissodia P, Sharma L: Control of multidrug resistant bacteria in a tertiary care hospital in India. Antimicrob Resist Infect Control 2012;1:23. 33. Kollef MH, Micek ST. Strategies to prevent antimicrobial resistance in the intensive care unit. Crit Care Med 2005; 33: 1845-1853. 10. 34. Kristof S, Sofie Van H, Kristof T, et al: Design of Software Services for Computer-Based Infection Control and Antibiotic Management in the Intensive Care Unit. In International Conference on Health, Telemedicine, and Social Medicine. 2009:87-92. 35. Leung E, Weil DE, Raviglione M, et al: World Health Organization World Health Day Antimicrobial Resistance Technical Working Group: The WHO policy package to combat antimicrobial resistance. Bull World Health Organ 2011;89:390-2. 36. Leung V, Gill S, Sauve J: Growing a “Positive Culture” of Antimicrobial Stewardship in a Community Hospital. Can J Hosp Pharm 2011;64:314-20. 37. MacDougall C, Polk RE. Antimicrobial stewardship programs in health care systems. Clin Microbiol Rev 2005; 18: 638-656. 38. Molton JS, Tambyah PA, Ang BSP, et al: The global spread of healthcare-associated multidrugresistant bacteria: a perspective from Asia. Clin Infect Dis 2013;56:1310-8. 39. Monnet DL, MacKenzie FM, López-Lozano JM, et al: Antimicrobial drug use and methicillinresistant Staphylococcus aureus, Aberdeen, 19962000. Emerg Infect Dis 2004;10:1432-41. 40. Niwa T, Shinoda, Suzuki A, et al: Outcome measurement of extensive implementation of antimicrobial stewardship in patients receiving intravenous antibiotics in a Japanese university hospital. Int J Clin Pract 2012;10:1-10. 41. Ohl CA, Luther VP: Antimicrobial stewardship for inpatient facilities. J Hosp Med 2011;6:S4S15. 42. Paterson DL: “Collateral damage” from cephalosporin or quinolone antibiotic therapy. Clin Infect Dis 2004;38(Suppl 4):S341-5. 43. Peterson LR. Squeezing the antibiotic balloon: the impact of antimicrobial classes on emerging resistance. Clin Microbiol Inf 2005; 11: S4-S16. 44. Pulcini C, Defres S, Aggarwal I, et al. Design of a 'day 3 bundle' to improve the reassessment of inpatient empirical antibiotic prescriptions. J Antimicrob Chemother. 2008; 61: 1384-1388. 45. Richards MJ, Edwards JR, Culver DH, et al: Nosocomial infections in combined medicalsurgical intensive care units in the United States. Infect Control Hosp Epidemiol 2000;21:510-5. 46. Rosenthal VD, Maki DG, Graves N: The International Nosocomial Infection Control Consortium (INICC): goals and objectives, description of surveillance methods, and operational activities. Am J Infect Control 2008;36:1-12. 47. Rosenthal VD, Maki DG, Mehta A, et al: International Nosocomial Infection Control Consortium report, data summary for 2002-2007, issued January 2008. Am J Infect Control 2008;36:627-37. 48. Schouten JA, Hulscher ME, Trap-Liefers J, et al: Tailored interventions to improve antibiotic use for lower respiratory tract infections in hospitals: a cluster-randomized, controlled trial. Clin Infect Dis 2007;44:931-41. 49. Scott JG, Cohen D, DiCicco-Bloom B, et al: Antibiotic use in acute respiratory infections and the ways patients pressure physicians for a prescription. J Fam Pract 2001;50:853-8. 50. Septimus EJ, Owens RC Jr. Need and potential of antimicrobial stewardship in community hospitals. Clin Infect Dis. 2011; 53: S8-S14. 51. Sheng WH, Wang JT, Lu DC, et al: Comparative impact of hospital-acquired infections medical costs, length of hospital stay and outcome between community hospital and medical centres. J Hosp Infect 2005;59:205-14. 52. Spellberg B, Bartlett JG, Gilbert DN. The future of antibiotics and resistance. N Engl J Med 2013; 368: 299-302. 53.Singh N, Rogers P, Atwood CW, et al. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit: a proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med 2000; 162: 505-511. 54. Standiford HC, Chan S, Tripoli M, et al: Antimicrobial stewardship at a large tertiary care academic medical center; cost analysis before, during, and after a 7-year program. Infect Control Hosp Epidemiol 2012;33:338-45. 55.Tambyah PA, Knasinski V, Maki DG: The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care. Infect Control Hosp Epidermiol 2002;23:27-31. 56. Tseng SH, Ke YF, Chang FY: National action plan to combat antimicrobial resistance in Taiwan. J Microbiol Immunol and Infection 2014; 47:167 57. Tseng SH, Lee CM, Lin TY, et al: Combating antimicrobial resistance: antimicrobial stewardship program in Taiwan. Journal of Microbiology, Immunology and Infection 2012:45, 79-89. 58. Tseng YJ, Chen YC, Lin HC, et al: A webbased hospital-acquired infection surveillance information, in The 10th IEEE International Conference on Information Technology and Applications in Biomedicine. 2010:Corfu, Greece. 59. White AR, on behalf of the BSAC Working Party on The urgent need: regenerating antibacterial drug discovery and development. Effective antibacterials: at what cost? The economics of antibacterial resistance and its control. J Antimicrob Chemother 2011; 66: 1948-1953. 60. Wieland SC, Brownstein JS, Berger B, et al: Automated real time constant-specificity surveillance for disease outbreaks. BMC Med Inform Decis Mak 2007;7:15. 61. World Economic Forum: Global Risks 2013. 8th ed. Available http://www.weforum.org/reports/ global-risks-2013-eighth-edition. | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/18983 | - |
| dc.description.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。 | zh_TW |
| dc.description.abstract | 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. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-08T01:41:30Z (GMT). No. of bitstreams: 1 ntu-105-P02747021-1.pdf: 1377049 bytes, checksum: eb4c11cad6cbc4d8e3a53b7a854b37dd (MD5) Previous issue date: 2016 | en |
| dc.description.tableofcontents | 目錄
誌謝i 中文摘要ii Abstract iii 目錄iv 圖目錄v 表目錄v 第一章 緒論1 第一節 研究背景1 第二節 研究動機3 第三節 研究目的4 第二章 文獻探討5 第一節 抗生素抗藥性5 第二節 感染管制與抗生素使用管理9 第三節 抗生素管理25 第四節 資訊系統與醫療機構37 第三章 研究方法41 第一節 研究設計41 第二節 資料分析43 第四章 結果與討論45 第一節 研究結果45 第二節 討論50 第五章 結論51 參考文獻52 圖目錄 圖1 住院病人抗生素使用率47 圖2 住院抗生素總耗用量(DDD)47 圖3 住院病人抗生素藥費佔率47 圖4 抗生素藥費成長率47 圖5 住院病人管制性抗生素處方24小時內評估率47 圖6 住院病人管制性抗生素處方疑義比率47 圖7 CDAD發生密度(千人日) 48 圖8 全院醫療照護相關感染密度(千人日)48 圖9 全院醫療照護相關感染CREC抗藥性比率48 圖10 全院醫療照護相關感染CRKP抗藥性比率48 圖11 全院醫療照護相關感染CRPM抗藥性比率48 圖12 全院醫療照護相關感染CRECl抗藥性比率48 圖13 全院醫療照護相關感染CRPA抗藥性比率49 圖14 全院醫療照護相關感染CRAB抗藥性比率49 圖15 全院醫療照護相關感染MRSA抗藥性比率49 圖16 全院醫療照護相關感染VREfs抗藥性比率49 圖17 全院醫療照護相關感染VREfm抗藥性比率49 表目錄 表1 資訊系統輔助抗生素管理前後45 | |
| dc.language.iso | zh-TW | |
| dc.title | 資訊系統於抗生素管理之角色與成效探討 | zh_TW |
| dc.title | The Role and Impacts of Information System
in Antimicrobial Stewardship | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 104-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 盧信銘,謝冠雄 | |
| dc.subject.keyword | 抗生素管理,資訊系統,抗藥性細菌,醫療照護相關感染,感染管制,降階, | zh_TW |
| dc.subject.keyword | antimicrobial stewardship,information system,drug resistant bacteria,healthcare-associated infection,infection control,de-escalation, | en |
| dc.relation.page | 57 | |
| dc.identifier.doi | 10.6342/NTU201603290 | |
| dc.rights.note | 未授權 | |
| dc.date.accepted | 2016-08-19 | |
| dc.contributor.author-college | 管理學院 | zh_TW |
| dc.contributor.author-dept | 資訊管理組 | zh_TW |
| 顯示於系所單位： | 資訊管理組 | |
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