新生儿病房抗生素预防应用的效果评价

The Prophylactic Effect Evaluation of Antibiotics in Newborn Nursery

目的:探讨在新生儿病房实行普遍预防性应用抗生素和部分选择性预防应用抗生素的优缺点。方法:将连续2年入院的新生儿按开始开展C反应蛋白(CRP)筛查的时间为界分为普遍预防组(465例)和选择预防组(546例),普遍预防组是对存在感染高危因素的患儿常规给予抗生素预防可能发生的细菌感染,选择预防组必须有感染高危因素加C反应蛋白≥4 mg/L条件才预防性应用抗生素,统计两组的实际感染率、平均住院天数,人均日住院药品费用,红臀、鹅口疮的发生率,并做统计学检验。结果:普遍预防组的实际感染率11.83%,选择预防组的实际感染率为11.26%(P>0.05)。普遍预防组平均住院天数(11.8±3)d,选择预防组平均住院天数(7.5±2)d,人均日住院药品费用普遍预防组(135.8±36.5)元/(人.d),选择预防组(86.6±15.6)元/(人.d)。普遍预防组腹泻、红臀、鹅口疮的发生率分别为16.77%、16.34%、12.3%,选择预防组腹泻、红臀、鹅口疮的发生率分别为5.67%、8.24%、4.2%。五项指标比较,选择预防组都低于普遍预防组,差异均有统计学意义(P<0.01)。结论:有选择性地(CRP≥4 mg/L)预防性应用抗生素比不加选择的普遍预防应用抗生素有明显的优势,没有增加感染的发生率,同时降低了抗生素不良反应的发生率,减少了患者的经济负担,值得推广。

Objective：To compare the effect of prophylactic antibiotic utilization generally and conditionedly. Methods： The neonates administrated in our hospital in two years were divided into general prophylactic group （465 cases） which had high risk for infection and conditioned prophylactic group （546 cases） with CRP ≥4 mg/L at the same time, according to the time for CRP screening. Then the infection rate, hospital stay, cost for drugs, incidence rate of red buttocks and thrush were analyzed statistically. Results： For the general prophylactic group and the conditioned prophylactic group, the infection rate was 11.83% and 11.26%, respectively （P 〉 0.05 ）, the hospital stay was （ 11.8 ± 3） d and （ 7.5 ± 2） d, the drug cost was （ 135.8± 36.5 ） yuan eachday eachyone and （ 86.6 ± 15.6） yuan eachday eachyone. The incidence rate of diarrhea, red buttocks and thrush was 16.77% , 16.34% and 12.3% in the former group while in the conditioned prophylactic group was 5.67%, 8.24% and 4.2% , respectively. All had significant differences （P 〈0.01 ） except for the infection rate. Conclusions： Conditioned prophylactic utilization of antibiotics when CRP ≥4 mg/L in the neonate with high risk for infection is worth promoting for big decrease in untoward reaction rate and no increase in infection rate.