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| 題 名 | 某區域教學醫院抗生素審查之分享=Investigation of Antimicrobial use in Regional Teaching Hospital |
|---|---|
| 作 者 | 楊淑珍; 蔡佩玲; 莊謹如; 廖玲巧; 林綺英; | 書刊名 | 藥學雜誌 |
| 卷 期 | 33:4=133 2017.12[民106.12] |
| 頁 次 | 頁119-124 |
| 分類號 | 418.281 |
| 關鍵詞 | 抗生素; 合理性; 醫院藥師; Clinical pharmacist; Appropriate; Antibiotic; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 不適當使用抗生素造成的問題不僅是醫療成本的增加,更可能使病人遭受不必要 的不良反應與細菌抗藥性而增加治療的困難度。本研究藉由建立抗生素藥師與感染科 醫師共同照護模式,依巡診方式評估廣效抗生素,以期瞭解區域教學醫院開立廣效抗 生素的適當性。採取回溯性病例研究,分析院內在共照模式建立後,對廣效性抗生素 處方執行藥事照護介入的情形,以 SPSS 24.0依照類別變相使用卡方檢定。 本研究共審查349位病人與626筆抗生素處方,以加護病房處方居多。經評估後, 統計不適當抗生素處方的比例為42.8%,以處方 metronidazole 適當性明顯最低 (p = 0.000),其次依序為 carbapenems (p = 0.011) 與 penicillinase inhibitor combinations (p = 0.047);而 glycopeptides 雖不具有統計意義,但適當性趨勢也偏低 (p = 0.071)。醫療端 對抗生素劑量調整的接受度為97.7%,而對更改藥物選擇的接受度僅有91.1%。比較研 究前後藥師執行抗生素處方照護的介入行為,在與感染科醫師合作指導與討論下更能 增進藥師在審查處方選擇的能力 (p = 0.000)。 期許醫院藥師能在共同照護模式下,提升抗生素藥事照護的品質,並進一步提高 院內處方廣效性抗生素處方的合理性。 |
| 英文摘要 | Inappropriate use of antibiotics may increase the risk of adverse effects and result in the emergence of resistant bacteria. For identifying the common problems in prescription of antibiotics in our hospital, we assess the rationale of hospitalized patients who received antibiotic therapy retrospectively. Clinical pharmacists collaborating with the infectious disease physician performed ward round every week that focused on patients who received broad-spectrum antibiotics from Augst 1,2015 to Augst 1,2016. Appropriateness of antibiotics use was recorded and assessed based on the clinical conditions of patients, results of image studies, evidences of microbiological studies, the prescriptions of antibiotics, including the spectrum of coverage, dosage, treatment duration and side effects. Pearson’s chi-square test is used to discover if there were a relationship between categorical variables (as percentages) by using the SPSS 24.0. During the study period, 349 patients were treated with broad-spectrum antibiotics and total of 626 antibiotic prescriptions were evaluated. According to our assessment, 45.5% of antibiotics prescribed in our hospital were inappropriate. The most common error in antibiotic prescription was the combination use of metronidazole with broad-spectrum antibiotics that have anaerobic coverage, with rate as 8.87%(95% CI 3.21~24.46, p = 0.000).The rate of inappropriate use of carbapenems and penicillinase inhibitor combination were 2.18(95% CI 1.19~4.00, p = 0.0011) and 1.78(95% CI 1.01~3.15, p = 0.0047) respectively, higher than that of 3rd~4th cephalosporins.Our study also showed that there was a significant improvement of optimal antibiotic use regarding the dosage and choice of antibiotic after our intervention (p = 0.000). Errors in antibiotic prescription including choice of drug, dosage and lack of deescalation after microbiologic results available are common in hospital. Optimization of antibiotic use can be improved by setting up a collaboration team between clinical pharmacist and ID physician. |
本系統中英文摘要資訊取自各篇刊載內容。