剖腹產手術預防性抗生素之使用是否符合指引與醫療結果及費用之相關

Abstract

背景與目的：預防性抗生素的使用已經被證實能夠有效降低手術傷口感染的機會，在過去數十年間也不斷有相關組織發表適當使用預防性抗生素的多種建議。本研究將以2004年發布的「台灣外科手術預防性抗生素使用指引」為依據，針對剖腹產手術進行預防性抗生素使用是否符合指引的相關研究，以了解在2004年國內手術預防性抗生素使用指引發布後，剖腹產手術使用預防性抗生素符合指引的情況，並探討符合預防性抗生素使用指引的產婦是否會有較好的醫療照護結果。 方法：本研究利用2005到2007年全民健保資料庫百萬承保抽樣歸人檔進行次級資料分析，抓取三年間有接受剖腹產手術的產婦共8,518人次為研究對象。以逐步羅吉斯迴歸和逐步複迴歸方法，找出與是否符合指引相關的醫師特性和醫療機構特性，接著探討剖腹產手術預防性抗生素使用是否符合指引和醫療結果的相關。 結果：研究對象8,518人次中，剖腹產預防性抗生素之指引符合率為19.58%，平均每人次使用2.11種抗生素，其中以第一代頭孢子菌類為最常使用的抗生素。研究結果顯示，沒有符合剖腹產預防性抗生素使用指引的產婦出院後七日內發生手術傷口感染的機會較高，且藥費和醫療費用的花費也較多。 結論：剖腹產手術符合預防性抗生素使用指引有較好的醫療結果。雖然剖腹產預防性抗生素的使用指引符合率有逐年上升的現象，然而不論從抗生素種類的選擇、各年符合率或三年總符合率觀察，國內對於預防性抗生素使用指引的遵從度仍有待改善。若相關單位針對醫療提供者特性擬定政策或宣導，應能有效改善國內剖腹產手術預防性抗生素的使用情形。

Background and objectives: Using antibiotics prophylaxis has been proven to be effective in reducing the incidence of surgical site infections. Although several guidelines for using antibiotics prophylaxis have been published in past decades, the implementation of these guidelines is unsatisfactory. The main purpose of this study is to understand the status of adherence to guidelines, introduced in 2004, for using antibiotics prophylaxis in cesarean section in Taiwan and to evaluate the association between guideline adherence and health care outcomes. Method: This study used claims data file of 1 million sampled registry from Taiwan National Health Insurance Research Database. A total of 8,518 cesarean sections from 2005 to 2007 were included in the study. Logistic regression and multiple linear regression were used to test the relationships between guideline adherence and characteristics of health care providers, and to examine the association between guideline adherence and health care outcomes. Results: Of the 8,518 procedures, the guideline adherence rate was 19.58%; the average use of antibiotics prophylaxis is 2.11 types for each of the births, and the most frequently prescribed antibiotics were first-generation cephalosporins. Births in non-adherence group had significantly higher surgical site infection rate within seven days after discharge and had higher drugs cost and medical expenditure. Conclusion: The study showed that adherence to guideline in cesarean section had better health care outcomes. Although the guideline adherence of antibiotics prophylaxis is improving in Taiwan, it still has lots of space for improvement. Therefore, the authorities should make policy according to the health care providers’ characteristics to improve the guideline adherence of antibiotics prophylaxis in cesarean section.