儿童重症监护病房病原菌检测和抗菌药物使用调查分析
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摘要
目的:分析儿童重症监护病房(PICU)患儿病原菌分布和抗菌药物应用情况,为促进合理用药提供依据。方法:回顾性调查2014年10月至2016年10月无锡市儿童医院PICU使用抗菌药物患儿住院病历,分析病原菌检测结果、临床诊断和抗菌药物应用状况。结果:226例使用抗菌药物的患儿共送检362份标本,检出68株细菌和真菌,阳性率18. 78%。按检出率排序,前3位为大肠埃希菌(27. 94%)、金黄色葡萄球菌(22. 06%)和肺炎克雷伯菌(13. 24%)。有感染诊断的199例患儿中呼吸道感染占73. 37%。226例患儿共使用263例次抗菌药物,其中联合用药36例,占15. 93%,使用第三代头孢菌素(含酶抑制剂的复方制剂)及氧头孢烯类抗菌药物187例,占71. 10%。不合理医嘱排名前3位分别为遴选药品不适宜31条(41. 89%),适应证不适宜15条(20. 27%),用法用量不适宜14条(18. 92%)。抗菌药物费用占总药品费用34. 03%。结论:无锡市儿童医院PICU病原学送检率较高,但部分患儿存在适应证不适宜、用法用量不适宜、更换药品不合理等现象,需要加强抗菌药物合理使用的管理。
Objective: To analyze the distribution of pathogen and application of antibiotics in pediatric intensive care unit(PICU),so as to provide reference for the rational drug application. Methods: The inpatient medical records of children with antibiotics used in PICU of Wuxi Children's Hospital from Oct. 2014 to Oct. 2016 were retrospectively investigated,and the detection results of pathogen,main diagnosis and application status of antibiotics were analyzed. Results: A total of 226 cases of children with antibiotics were enrolled in 362 specimens,and 68 strains of bacteria and fungi were detected,with a positive rate of 18. 78%. The top three bacteria ranked by detection rate were Escherichia coli( 27. 94%),Staphylococcus aureus( 22. 06%) and Klebsiella pneumoniae( 13. 24%). Respiratory infections accounted for 73. 37% of 199 cases of children with infection diagnosis. A total of 263 cases of antibiotics were used in 226 cases of children,of which 36 cases were combined,accounting for 15. 93%,and 187 cases of third-generation cephalosporins(compound preparation containing enzyme inhibitors) and oxygen-cephem-based antibiotics were used,accounting for 71. 10%. The top three irrational medical orders were respectively improper selection of drugs(31,41. 89%),inappropriate indications( 15,20. 27%)and irrational usage and dosage(14,18. 92%). The cost of antibiotics accounted for 34. 03% of the total drug cost. Conclusion: The rate of pathogenic examination of pathogen in PICU of Wuxi Children's Hospital is relatively high,but there are still some irrational phenomenon such as improper selection of drugs,inappropriate indications and irrational usage and dosage. It is necessary to strengthen the management of rational application of antibiotics.
Objective: To analyze the distribution of pathogen and application of antibiotics in pediatric intensive care unit(PICU),so as to provide reference for the rational drug application. Methods: The inpatient medical records of children with antibiotics used in PICU of Wuxi Children's Hospital from Oct. 2014 to Oct. 2016 were retrospectively investigated,and the detection results of pathogen,main diagnosis and application status of antibiotics were analyzed. Results: A total of 226 cases of children with antibiotics were enrolled in 362 specimens,and 68 strains of bacteria and fungi were detected,with a positive rate of 18. 78%. The top three bacteria ranked by detection rate were Escherichia coli( 27. 94%),Staphylococcus aureus( 22. 06%) and Klebsiella pneumoniae( 13. 24%). Respiratory infections accounted for 73. 37% of 199 cases of children with infection diagnosis. A total of 263 cases of antibiotics were used in 226 cases of children,of which 36 cases were combined,accounting for 15. 93%,and 187 cases of third-generation cephalosporins(compound preparation containing enzyme inhibitors) and oxygen-cephem-based antibiotics were used,accounting for 71. 10%. The top three irrational medical orders were respectively improper selection of drugs(31,41. 89%),inappropriate indications( 15,20. 27%)and irrational usage and dosage(14,18. 92%). The cost of antibiotics accounted for 34. 03% of the total drug cost. Conclusion: The rate of pathogenic examination of pathogen in PICU of Wuxi Children's Hospital is relatively high,but there are still some irrational phenomenon such as improper selection of drugs,inappropriate indications and irrational usage and dosage. It is necessary to strengthen the management of rational application of antibiotics.
引文
[1]丁辉,甄琴,沈叙庄.儿科重症监护病房抗菌药使用的多中心流行病学调查[J].武警后勤学院学报(医学版),2010,19(12):1005-1008.
[2]王辉.规范临床微生物标本送检流程需要你我他[J].中华临床实验室管理电子杂志,2013,1(1):15-17.
[3]李玖军,陈艳飞. 2005~2012年中国医科大学附属盛京医院PICU疾病谱分析[J].中国当代儿科杂志,2013,15(6):472-476.
[4]崔娟,王佳,姚慧生,等. 2006-2010年儿童肺炎支原体感染流行病学分析[J].中国实用儿科杂志,2013,28(6):446-448.
[5]许政敏,王智楠,姚红兵.儿童急性感染性鼻-鼻窦炎诊疗——临床实践指南(2014年制订)[J].中国实用儿科杂志,2015,30(7):512-514.
[6]GILBERT D N,CHAMBERS H F,ELIOPOULOS G M,et al.热病-桑福德抗微生物治疗指南[M].第46版.北京:中国协和医科大学出版社,2017:70.
[7]周佳,朱月钮,张明军,等.基于儿科万古霉素血药浓度监测模拟临床给药方案优化的研究[J].中国小儿急救医学,2015(6):383-386.
[8]LE S N. Guidelines for the management of suspected and confirmed bacterial meningitis in Canadian children older than one month of age[J]. Paediatrics&child health,2014,19(3):141-52.
[9]仇锦春,许静,徐进,等.碳青霉烯类药物致丙戊酸血药浓度异常影响因素分析[J].西部医学,2015,27(12):1874-1878.
[10]杨莉,肖永红,聂垚,等.抗菌药物不合理使用对住院费用的影响[J].北京大学学报医学版,2010,42(3):279-283.
[11]郭玉琴,钟晓祝,张静,等. PICU合理使用抗菌药物干预效果分析[J].中华医院感染学杂志,2016,26(1):59-61.
[12]龚文婷.临床药师参与儿童重症监护室患者抗感染药物治疗的药学监护[J].儿科药学杂志,2017,23(12):40-42.
[2]王辉.规范临床微生物标本送检流程需要你我他[J].中华临床实验室管理电子杂志,2013,1(1):15-17.
[3]李玖军,陈艳飞. 2005~2012年中国医科大学附属盛京医院PICU疾病谱分析[J].中国当代儿科杂志,2013,15(6):472-476.
[4]崔娟,王佳,姚慧生,等. 2006-2010年儿童肺炎支原体感染流行病学分析[J].中国实用儿科杂志,2013,28(6):446-448.
[5]许政敏,王智楠,姚红兵.儿童急性感染性鼻-鼻窦炎诊疗——临床实践指南(2014年制订)[J].中国实用儿科杂志,2015,30(7):512-514.
[6]GILBERT D N,CHAMBERS H F,ELIOPOULOS G M,et al.热病-桑福德抗微生物治疗指南[M].第46版.北京:中国协和医科大学出版社,2017:70.
[7]周佳,朱月钮,张明军,等.基于儿科万古霉素血药浓度监测模拟临床给药方案优化的研究[J].中国小儿急救医学,2015(6):383-386.
[8]LE S N. Guidelines for the management of suspected and confirmed bacterial meningitis in Canadian children older than one month of age[J]. Paediatrics&child health,2014,19(3):141-52.
[9]仇锦春,许静,徐进,等.碳青霉烯类药物致丙戊酸血药浓度异常影响因素分析[J].西部医学,2015,27(12):1874-1878.
[10]杨莉,肖永红,聂垚,等.抗菌药物不合理使用对住院费用的影响[J].北京大学学报医学版,2010,42(3):279-283.
[11]郭玉琴,钟晓祝,张静,等. PICU合理使用抗菌药物干预效果分析[J].中华医院感染学杂志,2016,26(1):59-61.
[12]龚文婷.临床药师参与儿童重症监护室患者抗感染药物治疗的药学监护[J].儿科药学杂志,2017,23(12):40-42.