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目的:分析评价南京某三甲医院抗菌药专项整治前后喹诺酮类抗菌药使用情况和发展趋势,为抗菌药临床应用专项整治活动及管理提供依据。方法:调取该院2010年(整治前)和2011~2013年(整治后)所用喹诺酮类抗菌药的使用记录,采用回顾性方法,对该类药物的销售金额、用药频度(DDDs)、限定日费用(DDC)、细菌耐药情况及药品不良反应进行统计分析。结果:整治后(2011~2013年)喹诺酮类抗菌药销售金额及占抗菌药总销售金额比例较整治前(2010年)有明显下降;整治前注射用门冬氨酸洛美沙星的销售金额和DDDs最高,整治后的2012~2013年,莫西沙星注射剂和盐酸左氧氟沙星注射液的销售金额最高,分别位于第1、2位;盐酸左氧氟沙星片和盐酸左氧氟沙星注射液的DDDs最高,分别位于第1、2位;莫西沙星注射剂DDC最高。主要耐药菌葡萄球菌、肠杆菌科细菌、非发酵菌对左氧氟沙星、诺氟沙星、环丙沙星的耐药率有所下降;整治后该院抗菌药所致不良反应例数及喹诺酮类抗菌药所致不良反应占抗菌药不良反应的比例低于整治前。结论:该院通过抗菌药专项整治,喹诺酮类抗菌药的各项应用指标明显改善,喹诺酮类抗菌药的合理应用也取得成效,专项整治的效果比较明显。但该院还应加强对第4代喹诺酮类抗菌药的临床应用加以督导。
Objective: To analyze and evaluate the usage and development trend of quinolone antibacterials before and after antibacterial treatment in a top three hospital in Nanjing, and to provide basis for clinical rehabilitative activities and management of antibacterials. Methods: The records of the use of quinolone antibacterials used in this hospital from 2010 (before remediation) and from 2011 to 2013 (after remediation) were retrieved. Retrospective methods were used to analyze the sales amount, frequency of DDDs, DDC, bacterial resistance and adverse drug reactions were statistically analyzed. Results: After the remediation (2011 ~ 2013), the sales amount of quinolone antibiotics and the total sales amount of antibacterials decreased significantly compared with that before remediation (2010); the sales amount of lomefloxacin aspartate DDDs were the highest, and the sales amount of moxifloxacin injection and levofloxacin hydrochloride injection were the highest in 2012-2012 after remediation, which were respectively located at the first and second place. The DDDs of levofloxacin hydrochloride tablets and levofloxacin hydrochloride injection were the highest, 2; moxifloxacin injection DDC highest. The resistant rate of main drug-resistant Staphylococcus aureus, Enterobacteriaceae and non-fermentative bacteria to levofloxacin, norfloxacin and ciprofloxacin decreased. After treatment, the number of adverse reactions caused by antibacterial drugs and quinolones Adverse reactions caused by antimicrobial agents accounted for less than the proportion of antimicrobial adverse reactions before remediation. Conclusion: The hospital through the special rectification of antibacterial drugs, quinolone antibacterial indicators of various applications significantly improved the rational use of quinolone antibacterials have achieved success, the effect of special rectification is obvious. However, the hospital should also strengthen the 4th generation quinolone antibacterial drugs to be supervised.