门诊上呼吸道感染途径及临床常用抗生素疗效调查

Route of an upper respiratory tract infection and clinical evaluation of common antibiotics used in outpatient care

目的调查门诊上呼吸道感染途径及临床常用抗生素治疗效果评价,指导临床用药。方法收集748例门诊上呼吸道感染患者临床资料,调查患者感染路径,分析患者感染病原学特征。调查患者治疗过程中的抗生素使用情况并评价临床治疗效果。提取肺炎链球菌DNA,并PCR扩增ermA、ermB、mefA、mefE、tetM、tetO共计6种常见耐药基因。结果 748例门诊上呼吸道感染患者中,感染途径中,家庭传播、办公场所、聚餐、聚会、医院环境、学校环境、其他传播途径分别占32.89%、18.05%、14.17%、10.96%、8.96%、6.95%和8.02%。抗生素的使用频率从高到低依次为阿奇霉素、头孢唑啉、头孢曲松、头孢噻肟及其他抗生素,使用率分别为41.98%、35.03%、18.98%、12.97%和10.96%。口服给药、静脉给药、肌注给药、其他给药途径的使用率分别为70.99%、22.59%、7.62%和3.88%。头孢菌素类与氨基糖苷类、头孢菌素类与大环内酯类、氨基糖苷类与大环内酯类的联合应用比率分别为4.01%、1.87%和0.94%,单独使用头孢菌素类、氨基糖苷类、大环内酯类一类药物的使用率分别为9.89%、1.07%和14.97%。748例患者,经上述抗生素治疗后,疗效优337例,占45.05%,疗效良381例,占50.94%,疗效中23例,占3.07%,疗效差7例,占0.94%,疗效优良率可达95.99%。结论抗生素治疗时,阿奇霉素、青霉素、头孢唑啉及头孢曲松使用频度高;主要给药方式为口服给药和静脉治疗;应降低联合用药使用频率。

Objective To examine routes of an upper respiratory tract infection and clinical evaluation of common antibiotics used in outpatient care in order to guide clinical drug use. Methods Clinical data on 748 outpatients with an upper respiratory tract infection were collected, the route of infection was investigated, and etiological characteristics were analyzed in patients. The use of antibiotics during patient treatment was investigated and their clinical efficacy was evaluated. Streptococcus pneumoniae DNA was extracted. Six common drug resistance genes including ermA, ermB, mefA, mefE, tetM, and tetO were amplified using PCR. Results A total of 310 strains of pathogenic bacteria were isolated from 748 outpatients with an upper respiratory tract infection. Staphylococcus epidermidis accounted for 36.13% of those strains, Staphylococcus aureus accounted for 22.90%, Escherichia coli accounted for 17.10%, Pseudomonas aeruginosa accounted for 10.97%, Enterobacter cloacae accounted for 9.03%, and other pathogenic bacteria accounted for 3.87%. The infection was transmitted in a family setting in 32.89% of cases, in an office setting in 18.05%, at a meal in 14.17%, at a party in 10.96%, in a hospital environment in 8.96%, in a school environment in 6.95%, and by some other route in 8.02%. The antibiotics used most frequently were, in descending order, azithromycin(41.98%), cefazolin(35.03%), ceftriaxone(18.98%), cefotaxime(12.97%), and some other antibiotic(10.96%). The most frequent route of administration was, in descending order, orally(70.99%), intravenously(22.59%), intramuscularly(7.62%), and some other route(3.88%). Cephalosporins and aminoglycosides were used in combination in 4.01% of cases, cephalosporins and macrolides were used in combination in 1.87%, and aminoglycosides and macrolides were used in combination in 0.94%. Cephalosporins alone were used in 9.89% of cases, aminoglycosides alone were used in 1.07%, and macrolides alone were used in 14.97%. In the 748 patients treated with the aforementioned antibiotics, treatment was highly efficacious in 337 cases(45.05%), satisfactory in 381(50.94%), moderately efficacious in 23(3.07%), and slightly efficacious in 7(0.94%). Treatment was highly efficacious or satisfactory in 95.99% of cases. Conclusion Azithromycin, penicillin, cefazolin, and ceftriaxone were the most frequently used antibiotics. The main routes of administration were orally and intravenously. Cephalosporins and aminoglycosides were often used in combination, and the frequency of that combined use should be reduced.