儿童呼吸道感染病原学及抗菌药物使用分析

The study of etiology of respiratory infection and antibiotics employment in pediatric patients

目的 通过北京垂杨柳医院儿科近2年急性呼吸道感染患儿病原学检测,了解病原构成,分析抗菌药物使用情况.方法 取2年间北京垂杨柳医院院儿科就诊患儿93人.咽拭子送北京市疾病预防控制中心进行流感病毒、呼吸道合胞病毒、支原体等快速核酸检测.痰液送院内细菌室进行细菌培养.儿童药物利用指数（children drug utilization index,cDUI）评价抗菌药物用药剂量合理性.SPSS 18.0录入数据,x2检验组间差异,以P＜0.05为差异具有统计学意义.结果 婴幼儿占样本的70.96％,病毒检出率为62.37％,病毒阳性例数由高到低是：呼吸道合胞病毒（30.43％）、流感病毒（24.63％）、副流感病毒（10.14％）等.病毒阳性患儿并发下呼吸道感染比例（43.10％）高于阴性者（42.85％）.病毒阳性儿童患肺炎28例全部静脉输注抗菌药物.其中,痰培养4例（14.28％）可见致病菌,血常规4例（14.28％）阳性,共计8例（28.56％）见细菌感染证据,cDUI中位数1.05.呼吸道合胞病毒阳性患儿肺炎18例（85.71％）,cDUI中位数1.30.结论 本地区儿童下呼吸道感染多由病毒感染所致,预防性使用抗菌药物比例高.抗菌药物cDUI＞1.0现象普遍,即药物剂量偏大属于不合理用药.痰培养阳性率不高与门诊医师使用抗菌药物前未送检合格痰培养标本有关,应提高病原学检查意识,促进抗菌药物合理使用.

Objective To research the pathogenies＇ types and analyze the antibacterial drug＇ s using rationality from the children with acute respiratory infection,our study were generated by pediatric department from the hospital lasting 2 years.Methods A total of 93 pediatric patients with acute respiratory infection admitted from December 1,2010 through November 30,2012 were enrolled into study.The throat swabs from 93 patients were sent to the Beijing Center for Disease and Prevention （CDC） to identify the influenza virus,syncytial virus and mycoplasma with rapid nucleic acid test.The specimens of sputum from hospitalized patients were sent to the hospital bacterial laboratory for bacteria culture.With the Children Drug Utilization Index （cDUI）,the rationality of using antibiotics was estimated.The database was established by using SPSS version 18.0 software and the data were analyzed to determine the statistical distinction among the percentage by the Chi square test （P ＜ 0.05）.Results Of them,70.96％ pediatric patients were below 3 years old （excluding newborns）.Of them,62.36％ patients had positive findings of viral infection.The predominant viruses of respiratory infection were syncytial virus accounting for 30.43％,the influenza viruses 24.63％ and the para-influenza virus 10.14％.The patients with positive results in vital test were more vulnerable to lower respiratory infection than those with negative results.The pneumonia patients with positive finding of syncytial virus accounted for 85.71％ （18 patients） in which the median cDUI was 1.30.The antibiotics were given to 28 pneumonia patients with positive virus test,in which the median cDUI was 1.05.Of 28 pneumonia patients,4 （16％） had positive bacteria growth in sputum cultures,and 4 cases （16％） had positive bacteria growth in blood cultures.Conclusions In the district of hospital,the lower respiratory infection was usually caused by viruses.Therefore,antibiotics should not be given in patients without evidence of bacterial infection.It is a irrational strategy to use antibiotics in those patients when the Children Drug Utilization Index is high （＞ 1.0）.It is paramount important to notice that the percentage of positive bacteria growth in sputum cultures is usually not high because the antibiotics are given by OPD physicians before hospitalization of patients with bacterial infections in the acute respiratory illness.