台灣住院病人2000-2004抗生素使用之情形

Antibiotic Usage in Hospitalized Patients in Taiwan: 2000 to 2004

10.6526/ICJ.200608_16(4).0001

張上淳(Shan-Chwen Chang)；陳宜君(Yee-Chun Chen)；賴美淑(Mei-Su Lai)；張鴻仁(Hung-Jen Chang)

抗生素 ； 住院病人 ； antibiotic ； hospitalized patient

感染控制雜誌

16卷4期（2006 / 08 / 01）

205 - 218

繁體中文

爲了瞭解台灣近年來住院病人之抗生素使用情形，因而利用健保局2000年至2004年每年所有醫療院所住院病人之申報資料，進行有關抗生素使用的統計分析，其中每年醫學中心爲個合伯家、區域醫院爲63-71家、地區醫院爲366-447家、精神專科醫院爲32-36家。全體住院病人每年約爲269萬人次至299萬人次，每年這些病人使用抗生素之處方率爲62%-64.6%；抗生素藥費由2000年的新台幣67億成長至2004年的93億，各年度抗生素藥費佔各該年度總藥費的百分比分別爲43%-45%。醫學中心使用之抗生素藥費佔率最高，其次爲區域醫院，再其次爲地區醫院。不同科別中以內科住院病人使用抗生素最多，佔耗用金額的48.7%（2000年）-60.8%（2004年）；其次爲外科病人，佔37.5%（2000年）-29.5%（2004年）。所有使用抗生素的個案中，曾住過加護病人者僅佔案件數的8.3%-10.2%，但其抗生素金額卻佔全部住院病人抗生素金額的34.5%-40.4%。以全部曾住過加護病房之個案來看，大約80%的個案於住院過程中曾使用抗生素。由此結果，可以瞭解台灣醫療院所住院病人使用抗生素之比例非常高，耗用金額非常大，且持續增加中，尤其是醫學中心及加護病房的病人，日後若要設法改善住院病人之抗生素使用時，應特別以這些重點病人爲主要著力的目標。

In order to understand the antibiotic usage in hospitalized patients in Taiwan, we used the hospital claimed data from the Bureau of National Health Insurance during 2000 to 2004 to analyze the systemic antibiotics used for all hospitalized patients in all hospitals in Taiwan during these f1ve years. There were 1849 hospitals belonged to medical center, 63-71 regional hospitals, 366-447 local hospitals and 32-36 psychiatric hospitals in each individual year. The number of total hospitalized patients in each year ranged from 2.69 millions to 2.99 millions Sixty-two to sixty-four percent of them were prescribed with systemic antibiotics during the hospitalization course. Antibiotic costs per year increased from 6.7 billions NT dollars in 2000 to 9.3 billions NT dollars in 2004. The ant1biotic costs accounted for 43%-45% of total drug costs for all hospitalized patients in each year. The antibiotic costs spent for patients in medical centers accounted for the highest percentage, followed by regional hospitals. Most of the antibiotic costs were for patients in department of internal medicine (ranged from 48.7% in 2000 to 60 8% in 2004), followed by patients in department of surgery (ranged from 37.5% in 2000 to 29.5% in 2004). Among all hospitalized patients prescribed with antibiotic, those who had ever stayed in intensive care units (ICUs) accounted for only 8 3%-b 0% of cases, but the antibiotic costs for these patients accounted for 34.5%40,4% of total antibiotic costs for all hospitalized patients. The percentage of patients prescribed with antibiotics in patients who had ever stayed in ICUs was around 80%. From these results we can under star d the overall situation of antibiotic usage in all hospitalized patients in Taiwan. During past five years, the antibiotic usage increased continuously, especially in patients hospitalized in medical centers and in patients who had ever stayed in ICUs. If we want to evaluate and/or improve the rationality of antibiotic usage, these will be the main target to put our efforts on.

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