2533例剖宫产手术抗菌药物使用分析

Use of antimicrobial agents by 2533 patients undergoing cesarean section

目的分析2011年医院剖宫产手术抗菌药物使用情况,促进临床合理使用抗菌药物,遏制细菌耐药性,预防手术部位感染。方法调查2011年1-12月在医院行剖宫产的所有出院产妇抗菌药物使用情况,按是否存在感染分为两组,感染组为剖宫产手术合并感染者,非感染组为单纯剖宫产手术患者,分析抗菌药物使用情况。结果共监测剖宫产产妇2533例,全部使用抗菌药物,抗菌药物使用率100.0%,其中感染组709例占28.0%,非感染组1824例占72.0%;围手术期用药,按围术期用药2022例占79.8%,未按围术期用药511例占20.2%;术中出血>1500ml或手术时间>3h26例,追加使用8例占30.8%,未追加使用18例占69.2%;联合用药单用2364例占93.3%,二联153例占6.1%,≥3联16例占0.6%;用药时间<48h728例占28.7%;使用抗菌药物15种、2959例次,其中头孢呋辛2406例次占81.3%,克林霉素240例次占8.1%,左氧氟沙星102例次占3.4%,阿奇霉素81例次占2.7%,甲硝唑73例次占2.46%,头孢他啶24例次占0.8%。结论临床医师已普遍重视剖宫产围术期预防应用抗菌药物,用药品种及联合用药较规范,但存在疗程偏长、用药时机欠规范等问题,是今后需改进的问题。

OBJECTIVE To promote rational clinical use of antibiotics,to curb bacterial resistance and to prevent surgical site infection by analyzing the use of antimicrobial drug for cesarean section during 2011.METHODS The use of antibiotics by the discharged patients who underwent cesarean section in Jan-Dec,2011 was investigated,the patients were divided into two group according to the infection status,the patients with infections were set as the infection group,and the patients without infections were chosen as the non-infection group,the use of antibiotics was analyzed.RESULTS A total of 2533 cases of cesarean section were monitored,and the utilization rate of antibiotics was 100.0%,there were 709（28.0%） cases in the infection group and 1824（72.0%） in the non-infection group.There were 2022（79.8%） cases who were in accordance with perioperative medication and 511（20.2%） cases who were not in accordance with perioperative medication.There were 26 cases with the blood loss more than 1500 ml or the operation duration more than 3 hours,8（30.8%） cases with additional use of antibiotics,and 18（69.2%） cases without additional use of antibiotics.There were 2364（93.3%） cases with the use of single drug,153（6.1%） cases with two-drug use,and 16（0.6%） cases with combination use of more than three drugs.There were 728（28.7%）cases with the medication duration less than 48 hours.Of totally 15 types of antibiotics used for 2959 times,there were 2406（81.3%） case-times of cefuroxime,240（8.1%） case-times of clindamycin,102（3.4%） case-times of levofloxacin,81（2.7%） case-times of azithromycin,73（2.46%） case-times of metronidazole,and 24（0.8%） case-times of ceftazidime.CONCLUSION The clinicians have generally realized the importance of perioperative medication and the standardized combination use of antibiotics,but there are some problems like the excessively long treatment course and the irrational medication timing,which need to be solved.