SO SNH LIU K N HNG NGY

VI LIU XC NH TRONG NGY

CA KHNG SINH TI
BNH VIN NHN DN 115
Ch nhim ti: Hunh Hin Trung
Cng s:
Nguyn Th Thy H
Cao Th Thu Nga
Nguyn V Minh Duy
Ngi hng dn: Quc Huy

NI DUNG

1. t vn
2. Mc tiu nghin cu
3. Tng quan ti liu
4. i tng Phng php nghin cu
5. Kt qu - Bn lun
6. Kt lun Kin ngh

T VN

T VN
S dng KS cha hp l

khng KS

Lin quan n liu hng ngy.

Thi gian s dng.

Liu xc nh trong ngy (DDD: Defined Daily Dose)

(WHO)

Liu cho mt thuc vi ch nh chnh.

Theo di, gim st, nh gi th SD thuc.

Liu k n trong ngy (PDD: Prescribed Daily Dose)

Liu tht s k n.
C th khc DDD.

T VN
Nghin cu ca Arno Muller
Ch c fluoroquinolone v cephalosporin: PDD ~ DDD.
64 KS c PDD khc DDD.
Cc nhm khc: PDD khc DDD.

Vit Nam cha tm c nghin cu PDD - DDD

So snh PDD vi DDD nh gi s dng KS.
So snh liu k n hng ngy vi liu xc nh

trong ngy ca khng sinh ti Bnh vin Nhn dn 115

MC TIU NGHIN CU

MC TIU NGHIN CU
Mc tiu tng qut
So snh PDD vi DDD nh gi SDKS ti BVND115
t 7/2015 6/2016.

Mc tiu c th
T thng 7/2015 thng 6/2016:

1. So snh s DDD/1000 ngy ging ca KSSD theo khi.

2. So snh DDD vi PDD ca KSSD.
3. So snh t s: s DDD/s ngy TKS ca KS chnh SD
theo khi.

TNG QUAN TI LIU

TNG QUAN TI LIU

Liu xc nh trong ngy (DDD)

n v o lng c lp vi:
Gi, tin t, kch c ng gi, hm lng.

nghin cu tip cn xu th SD thuc.

Thc hin so snh gia cc nhm dn s.
Chun ha v tiu th KS trong BV.
Cho php thc hin so snh vi cc BV khc.
Gip ci thin cht lng s dng KS.

Cc bc tnh s DDD
Bc 1: Tnh tng lng thuc s dng
(hoc mua)/nm theo n v ti thiu
Bc 2: Tnh tng lng thuc tiu
th/nm theo n v mg/UI (g/UI) = s
lng x hm lng
Bc 3: s liu bc 2/ DDD ca thuc
kho st

Bc 4: s liu bc 3/ tng s bnh

nhn (hoc s dn)

S DDD/1000 ngy ging

n v chun khuyn co cho vic o lng s tiu th KS

cc BV.
DDD/1000 ngy ging =

Tng s DDD
Tng s ngy ging

So snh tiu th KS cc BV bt k khc bit:

Thnh phn thuc, hiu lc KS v SL BN ti BV.
p dng cho BN ni tr.

x 1000

TNG QUAN TI LIU

Liu k n trong ngy (PDD)

PDD c th c xc nh t NC k n.
PDD: lng thuc TB hng ngy thc s k n.
T s DDD/s ngy iu tr

So snh s DDD vi ngy iu tr.

T s = 1: S DDD = s ngy iu tr.

T s > 1: s DDD ln hoc ngy T nh.

T s < 1: s DDD nh hoc ngy T ko di.

NC GARP- VN v n v NCLS i hc Oxford +

B Y T

Kt qu NC trn 15 BV

Min Nam: 206,7 DDD/ 100 ngy - ging.

Min Bc: 270 DDD/ 100 ngy - ging.
Min Trung: 347 DDD/ 100 ngy - ging.
Bnh nh: 466 DDD/ 100 ngy - ging (cao nht).

Nghin cu ca Ion - Nedelcu N et al

Mc BV: lng KDSD: 72,6 DDD/ 100 ngy - ging.

Mc khi:
- Ni khoa:

61,2 DDD/100 ngy - ging.

- Ngoi khoa:

62,8 DDD/100 ngy - ging.

- Khoa HS ni/ngoi: 126 DDD/100 ngy - ging.

NC cc BV c, 941 BN ni tr (De With )

267 bnh nhn (28%) c k 471 KS.

1754 PDD ca KS.
Trong s 1754 PDD:
625 c DDD khp vi PDD (36%).
S khc nhau ln v DDD (<50% PDD khp DDD).
Ni bt: beta-lactam v macrolide.

I TNG - PPNC

I TNG - PPNC
Thit k nghin cu
M t, ct ngang, hi cu c phn tch.

Dn s chn mu
- NB ni tr s dng KS ti BVND115.

- T thng 7/2015 thng 6/2016.

Dn s mc tiu
NB ni tr s dng KS ti BVND115.

I TNG - PPNC
Tiu chun chn mu
- NB ni tr s dng KS ti BVND115.

- T thng 7/2015 thng 6/2016.

- KS nhm iu tr h thng (nhm J01).
Tiu chun loi tr
- NB khoa: YHCT - PHCN, dinh dng, CCTH.
- KSSD ti ch, metronidazol ung.

I TNG - PPNC
C mu

Tt c NB ni tr SDKS ti BVND115.
T 01/07/2015 30/06/2016 theo cc TC trn.
Trong NC chn c 23.791 BN SDKS, 47 KS.

I TNG - PPNC
Phng php tin hnh
Tnh cc bin s sau

S DDD/1000 ngy - ging ca tng KS:

- S gram KS s DDD (Tng s gr/DDD)

- S DDD/s ngy - ging x 1000

Tnh ton t sut ca: s DDD/ s ngy iu tr

So snh DDD vi PDD
PDD = t sut (s DDD/ s ngy iu tr) x DDD

I TNG - PPNC
Thu thp s liu

Tn bnh nhn, tui, gii, bnh.

S ngy nm vin (ngy ra vin - ngy vo vin).
Chn on bnh.
Tn khng sinh, hm lng/nng .
n v tnh, s lng s dng, khoa.
Phng php x l s liu

S dng Excel 2007 x l thng k, php kim t.

KT QU - BN LUN

KT QU - BN LUN

T 7/2015 - 6/2016:

s DDD ca KS (nhm J01): 382.298.

Tng s BN: 86.872 ngi,
Trong c 23.791 (37,7%) BN s dng KS.

KT QU - BN LUN
KQ phn tch s DDD/1000 ngy ging ca tt c KS

Khi

S ngy ging

S DDD

DDD/1000

16.379

23.661

1.444,6

Khi ngoi

186.476

184.887

991,5

Khi ni

153.478

173.749

1.132,1

Tng

356.333

382.298

Hi sc tch cc

KT QU - BN LUN
So snh s DDD/1000 ngy ging ca NC:
BVND115 vi Arno Muller, Ion-Nedelcu N
3500

3000

2500

2000

1500

1000

500

0
Hi sc tch cc

Khi ngoi
Nghin cu BVND115

Khi ni
Arno Muller

Ion-Nedelcu N.

Tnh chung

So snh s DDD, s ngy iu tr v t sut s DDD: s ngy iu tr nhm J01

lactam

160000

140000

120000

1.8

lactam khc

1.6

Quinolone

1.4

Macrolide,
lincosamidev
streptogramin
Khng sinh khc

1.2

100000

1
80000

Glycopeptide
0.8
Polymyxin B

60000

0.6
S DDD
40000

20000

S ngy KS

Aminoglycoside
0.4
Sulfonamidev
trimethoprim

0.2

Tetracycline

0
DDD/s ngy T

-2

-4

-6
amoxicillin and enzyme inhibitor
ceftriaxone
levofloxacin
cefuroxime
ciprofloxacin
meropenem
ampicillin and enzyme inhibitor
ceftazidime
cefoperazone
moxifloxacin
fosfomycin
levofloxacin
ertapenem
clarithromycin
vancomycin
ciprofloxacin
colistin
cefixime
cefuroxime
imipenem and enzyme inhibitor
amikacin
amoxicillin and enzyme inhibitor
clindamycin
cefoperazone, combinations
gentamicin
piperacillin and enzyme inhibitor
cefepime
amoxicillin
ticarcillin and enzyme inhibitor
cefazolin
ceftizoxime
sulfamethoxazole
clindamycin
cefaclor
doxycycline
cefpirome
azithromycin
linezolid
norfloxacin
cefpodoxime
tigecycline
cefalexin
azithromycin
oxacillin
cefdinir
erythromycin
cefadroxil

Chnh lch PDD -DDD

10

- PDD=DDD: 12/47 thuc

- PDD<DDD: 20/47 thuc
- PDD>DDD: c 15 thuc

Liu k n <DDD

-8

-10
Chnh lch PDD -DDD

T sut s DDD: s ngy iu tr ca cc KS chnh

Tn khng ng
Khi ni
sinh
dng
amoxicillin v
enzyme
Ung
2,2
inhibitor
ceftriaxone

tim

1,04

levofloxacin

tim

1,2

cefuroxime

Ung

2,04

ciprofloxacin

tim

1,02

Khi ngoi
(P*)
2,1

Hi sc tch cc
(P1*,P2*)
1,9

(<0,000)

(0,2;0,7)

1,05
(0,4)
1,5
(0,000)
2,15
(0,1)
0,88
(0,000)

0,98
(0,001;0,000)
1,6
(0,000;0,000)
ND*
1,31
(0.000;0.000)

Ceftriaxone, ciprofloxacin: PDD=DDD

- Khng khc khi phn tch chung.
- Khc khi phn tch ring.

P*: Khi ngoi vs Khi ni; P1*: Hi sc tch cc vs Khi ni; P2*: hi sc tch cc vs Khi ngoi; ND*: khng tnh, s lng nh hn 30

T sut s DDD: s ngy iu tr ca cc KS chnh

Tn khng sinh

ng
Khi ni
dng

meropenem

tim

1,27

ampicillin v
enzyme inhibitor

Tim

1,3

ceftazidime

Tim

0,69

cefoperazone

tim

0,71

Khi ngoi
(P*)
1,27
(0,9)
1,1
(0,000)
0,53
(0,000)
0,50
(0,000)

Hi sc tch cc
(P1*,P2*)
1,27
(0,9;0,9)
2,87
(0,000;0,000)
1,07
(0,000;0,000)
0,81
(0,02;0,000)

Cao nht khoa HSTC.

Tr amoxicillin v c ch enzyme, ceftriaxone.

P*: Khi ngoi vs Khi ni; P1*: Hi sc tch cc vs Khi ni; P2*: hi sc tch cc vs Khi ngoi; ND*: khng tnh, s lng nh hn 30

im hn ch ca nghin cu
Phn loi BN cc khi cha tht chnh xc.
BN qu ti ti khoa HSTCC, chuyn Khoa GMHS
D liu KS c tnh cho Khoa GMHS.

Vic tnh ngy ging kh khn.

Mt s BN chuyn gia cc khoa.
Kh phn bit thi gian BN tng khi.
Phn liu KS t d liu gp kh khn.
C ch cung ng thuc thay i lin tc

Ngun thuc khng n nh.

KT LUN KIN NGH

KT LUN KIN NGH

Kt qu NC p ng cc mc tiu sau:
1. So snh s DDD/1000 ngy ging ca KSSD theo
khi:

Hi sc tch cc (1.444,6);
Khi ni (1.132,1);
Khi ngoi (991,5).

2. So snh DDD vi PDD ca KSSD:

PDD = DDD: 12/47 thuc;
PDD < DDD: 20/47 thuc;
PDD > DDD: c 15 thuc.

KT LUN KIN NGH

Kt qu NC p ng cc mc tiu sau (tip theo):
3. So snh t sut: s DDD/s ngy TKS ca KS chnh

SD theo khi:
S DDD vt qu s ngy TKS : 20%.
T sut: s DDD/s ngy TKS ch ra s khc nhau,

ty thuc khoa LS.

Thng cao nht khoa HSTC.

Tuy nhin, s khc nhau ny khng th hin :

Amoxicillin v c ch enzyme;
Ceftriaxone.

KT LUN KIN NGH

S DDD khng phn nh chnh xc SNT KS ti

BVND115.
Ch s PDD phn nh tt hn thi gian s dng KS.
Ch s DDD tt so snh s dng KS:
Cc BV trong cng khu vc, cng quc gia.
So snh quc t.

Cn nghin cu su hn v DDD, PDD

Nng cao hiu qu k n KS.

CM N CC ANH/CH
CH LNG NGHE