日本供应中断期间头孢唑林短缺对肠外抗生素选择和成本的影响：一项基于控制的中断时间序列分析。

Impact of the cefazolin shortage on the selection and cost of parenteral antibiotics during the supply disruption period in Japan: A controlled interrupted time series analysis.

机构信息

Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.

出版信息

J Infect Public Health. 2023 Mar;16(3):467-473. doi: 10.1016/j.jiph.2023.01.021. Epub 2023 Jan 31.

DOI:10.1016/j.jiph.2023.01.021

PMID:36738690

Abstract

BACKGROUND

A serious shortage of cefazolin (CEZ) occurred in Japan in 2019. We compared the impact of the CEZ shortage on the selection of parenteral antibiotics at affected and non-affected hospitals.

METHODS

The data were extracted from a nationwide Japanese administrative database and included all hospitalized cases between April 2016 and December 2020. We defined 'hospitals with shortage' as those hospitals with a statistically significant decrease in the use of CEZ during the supply disruption period compared to the same months of the previous year; other hospitals as 'hospitals without shortage'. We determined the proportion of each selected parenteral antibiotic use to the sum of all selected antibiotic use in the two groups of hospitals during the supply disruption period and during the same months of the previous year. A controlled interrupted time series (CITS) analysis was conducted to estimate the impact of the CEZ shortage on each antibiotic use and the cost of all parenteral antibiotics per patient day in hospitals with shortage as compared to those without shortage.

RESULTS

In the hospitals with shortage, the proportion of CEZ use to the sum of all selected antibiotics decreased (23.5-11.1%). The decrease in CEZ use was mainly offset by the use of ceftriaxone, ceftriaxone, and ampicillin/sulbactam. The CITS analysis showed a statistically significant increase in the use of broader-spectrum beta-lactams and clindamycin during the supply disruption period (flomoxef up 58.1%, cefotiam up 63.1%, cefmetazole up 14.5%, ceftriaxone up 13.9%, and clindamycin up 20.1%). The analysis showed no statistically significant change in the cost of all parenteral antibiotics per patient day.

CONCLUSIONS

During the CEZ supply disruption, there was a statistically significant increase in the use of broader-spectrum beta-lactams and clindamycin in hospitals with shortage compared with those without shortage.

摘要

背景

2019 年日本出现了头孢唑林（CEZ）严重短缺的情况。我们比较了 CEZ 短缺对受影响和不受影响医院选择肠外抗生素的影响。

方法

数据来自日本全国性行政数据库，包括 2016 年 4 月至 2020 年 12 月期间所有住院患者。我们将“短缺医院”定义为在供应中断期间，与前一年同期相比，CEZ 使用量呈统计学显著下降的医院；其他医院为“非短缺医院”。我们确定了两组医院在供应中断期间和前一年同期内，每种选定的肠外抗生素的使用比例占所有选定抗生素使用的总和。对短缺医院与非短缺医院的 CITS 分析，以评估 CEZ 短缺对每种抗生素使用的影响，以及每个患者日所有肠外抗生素的成本。

结果

在短缺医院中，CEZ 占所有选定抗生素的比例下降（23.5-11.1%）。CEZ 使用量的减少主要被头孢曲松、头孢曲松和氨苄西林/舒巴坦所抵消。CITS 分析显示，在供应中断期间，广谱β-内酰胺类和克林霉素的使用呈统计学显著增加（氟氧头孢增加 58.1%，头孢噻肟增加 63.1%，头孢美唑增加 14.5%，头孢曲松增加 13.9%，克林霉素增加 20.1%）。分析显示，每个患者日所有肠外抗生素的成本没有统计学显著变化。