中文摘要：

目的 了解2011-2015年第三季度全国183家三级甲等医院住院患者抗菌药物的使用情况，评价政策干预效果并发现问题，为指导下一步政策干预提供方向。方法 通过国家抗菌药物临床应用监测网收集2011-2015年第三季度全国183家三级甲等医院住院患者抗菌药物使用数据，从品种数量、消耗金额、用药频度（DDDs）、金额和DDDs序号比4个方面进行综合分析。结果 2011-2015年第三季度抗菌药物品种数量减少129种，减幅最大的药物是喹诺酮类抗菌药物；抗菌药物消耗金额和DDDs在2011-2012年下降幅度最大，分别下降24.98%和15.92%，后又呈增加趋势，其中消耗金额回升较快。头孢菌素类抗菌药物在不同年度品种数量、消耗金额和DDDs各维度占比均最高，平均占比分别为25.85%、38.80%和46.35%。2011-2015年，碳青霉烯类和其他β-内酰胺类（氨曲南）抗菌药物消耗金额逐年升高，增长率从12.20%上升到22.53%，美罗培南消耗金额占比稳居全体抗菌药物金额费用第一位，2015年前三季度占比达到8.23%，从2013年开始，亚胺培南/西司他汀钠稳居第二位，2015年前三季度占比达到4.93%。左氧氟沙星和头孢呋辛稳居各年度DDDs消耗占比前两位且有继续增加趋势，2015年前三季度占比分别为9.04%和5.91%。各年度不同类别抗菌药物使用金额与DDDs排序比平均值最大的是喹诺酮类抗菌药物（2.40），最小的是碳青霉烯类和其他β-内酰胺类药物（氨曲南）（0.39）。结论 一系列抗菌药物管理政策实施后，医疗机构对抗菌药物品种数量和用药频度控制有效果，但是金额控制比较乏力。头孢菌素类是三级医院使用最多的抗菌药物，限制使用级和特殊使用级抗菌药物使用增加，加重了患者负担。

英文摘要：

Objective To examine antimicrobial usage among inpatients in tertiary first-class hospitals in China and to evaluate intervention effects of management policy for providing references to future policy intervention.Methods Data on antimicrobial usage among inpatients in 183 tertiary first-class hospitals across China during the period from 2011 to third quarter of 2015 were collected from National Center for Antibacterial Surveillance （CAS）.The quantity and the number of types of antibacterial used,costs,defined daily doses （DDDs）,and the ratio between rank order number of cost and rank order number of DDDs for an antibacterial were analyzed comprehensively.Results The number of various types of antimicrobial used was reduced by 129 from 2011 to third quarter of 2015,with the greatest reduction in the usage of fluoroquinolones.The greatest reduction in antimicrobial usage costs （24.98%） and DDDs （15.92%） occurred between 2011 and 2012,but then both the costs and DDDs increased and the costs increased rapidly.Among all antimicrobials used during the period,the average proportion of cephalosporins was the highest for the number of types （25.85%）,costs （38.80%）,and DDDs （46.35%）.The costs for carbopentem and other β-lactam antimicrobials （aztreonam） increased yearly,with the growth rates from 12.20% to 22.53% in the study period.For all the antimicrobial usages,the costs of meropenem was the highest,accounting for 8.23% of the total cost during the first three quarters of 2015;the costs of imipenem/cilastain sodium usage was the second highest from 2013,accounting for 4.93% of the total cost of during the first three quarters of 2015.The two highest DDDs values were for levofloxacin and cefuroxime usage and showed a continuous increasing trend during the period,accounting for 9.04% and 5.91% of the total DDDs for the first three quarters of 2015.The antimicrobial usage with the maximum ratio （2.40） between rank order number of cost and rank order number of DDDs is fluoroquinolones