394例学龄儿童流感样病例临床调查及抗菌药物的应用

Clinical investigation and antibiotic treatment in 394 cases of school-agechildren with influenza-like illness

目的调查2014年冬季学龄儿童流感样病例(ILI)的临床特点,并分析抗菌药物使用情况,为该疾病的临床诊疗提供参考。方法针对于本院感染科开具复课证明的394例学龄儿童ILI,调查患者的一般情况、临床症状、实验室检查、就诊情况、治疗和预后。根据是否使用抗菌药物分为两组,进行回顾性病例对照研究。应用SPSS 13.0统计软件进行统计学处理,计量资料采用t检验或秩和检验,计数资料采取χ2检验。结果 394例学龄儿童ILI中,未用抗菌药物组及使用组病例在性别、年龄、最高体温、伴有咳嗽、咽痛、头痛、卡他症状、热程及病程方面比较,差异均无统计学意义;未使用抗菌药物组白细胞(WBC)总数、中性粒细胞计数低于使用抗菌药物组,差异具有统计学意义;本组病例抗菌药物使用率分别为:一级医院为84.2%(149/177),三级医院为69.6%(110/158),未就诊病例为63.6%(35/55)。一级医院抗菌药物使用率高于三级医院及未就诊者,差异具有统计学意义;共25例(6.3%)患儿进行了甲型流感病毒胶体金免疫层析法(GICA),快速诊断试纸条进行抗原检测或逆转录聚合酶链反应(RT-PCR)检测;仅有5例(1.3%)甲型流感病毒抗原阳性者给予奥司他韦抗病毒治疗。结论学龄儿童ILI抗菌药物使用率较高,抗菌药物的使用并不能影响其临床表现及预后;在流感季节,各级医院应该积极开展针对该类人群ILI的流感病毒病原学监测工作,以便提供更有针对性的诊治依据;同时临床医生应该加强掌握合理使用抗菌药物及抗病毒药物指征。

Objective To investigate the clinical characteristic and antibiotic treatment in 394 cases of school-agechildren with influenza-like illness（ILI） in the winter of 2014, and to provide the reference for clinical diagnosis and treatment. Methods Total of 394 school-agechildren with influenza-like illness who need the proof of full recovery for class in our infection clinic were analyzed using case-control study, retrospectively. All the cases were divided into two groups according to whether or not using antibiotics. The general conditions, clinical character, laboratory tests, whether or not visited hospital, the grade of hospital, treatment and prognosis were compared, respectively. Statistical analysis were taken by SPSS 13.0 software, the comparison of quantitative data was done using independent t test or rank test, and the qualitative data was compared using Chi-square test. Results The gender, age, the highest body temperature, cough, sore throat, headache, catarrhal symptoms, fever time and days from onset to recovery in the 394 school-agechildren with ILI between the two groups were not significantly different. The total white blood cell and neutrophils count were significantly lower in patients with non-antibiotic treatment compared with patients with antibiotic treatment. The utilization rates of antibiotics were investigated in first-grade hospital, third-grade hospital, and non-attendance in hospital as follows： 84.2%（149/177）, 69.6%（110/158） and 63.6%（35/55）. The differences between first-grade hospital and third-grade hospital were significant, but third-grade hospital and non-attendance in hospital were with significant differences. Twenty-five（6.3%） cases were detected with influenza A viruses by GICA or RT-PCR, only 5（1.3%） cases with influenza A antigen positive using the rapid detection of GICA were given oseltamivir for antiviral therapy. Conclusions The utilization rate of antibiotics was high in school-agechildren with influenza-like illness. Whether or not using antibiotics has no effect on clinical manifestation and prognoses. The work of monitoring influenza virus pathogen for the patients with ILI in the flu season should be actively carried out, so as to provide good technical support for clinical diagnosis and treatment. At the same time. The clinic should be strengthened to master the reasonable evidence for the use of antibiotics and antiviral treatment.