两种抗菌药物应用策略对新生患儿治疗结局及肠道菌群的影响

Effects of two antibiotics application strategies on treatment outcomes and intestinal flora of children

目的主要是探究新生患儿使用抗菌药物的策略对治疗结果的影响。方法选择2015年1月-2017年10月在丽水市妇幼保健院住院的新生患儿进行研究,共1977例。其中2015年1月-2016年5月新生患儿为对照组,共997例,抗菌药物的使用主要是根据风险评估的策略进行;在该策略中包括:早产以及产程延长等感染高危因素的患儿,入院时出现了败血症以及休克或者是颅内感染等严重感染症状的病例患儿。2016年6月-2017年10月住院新生患儿980例为研究组,按照风险评估加感染筛查及监测策略使用抗菌药物。分别对比两组患儿抗菌药物使用率、平均住院日、再入院率和病死率。结果抗菌药物应用策略改变后,住院新生患儿抗菌药物使用率明显降低(P<0.05)。两组治愈率、治愈时间均无显著性差异。在使用1周的抗菌药物以后,与对照组相比,研究组中益生菌的数量显著降低(P<0.05)。结论对住院的新生患儿抗菌药物的使用策略进行改变,由原来的风险评估改变成风险评估与监测和筛查结合的方式,能够明显减少抗菌药物使用率,而且不会对患儿产生不良影响。

OBJECTIVE To explore the impact of antibiotics application strategies on treatment outcomes of neonates.METHODS A total of 1977 neonates who were hospitalized Lishui Maternal and Child health Care Hospital from Jan 2015 to Oct 2017 were enrolled in the study,997 of whom were hospitalized from Jan 2015 to May 2016 and assigned as the control group.The antibiotics were used mainly based on the risk assessment strategies,including the high risk factors such as premature delivery and prolonged labor and the severe infection symptoms like sepsis,shock and intracranial infection.Totally 980 neonates who were hospitalized from Jun 2016 to Jun 2017 were set as the study group and treated with antibiotics based on the risk assessment combined with screening and surveillance of infection.The utilization rate of antibiotics,average length of hospital stay,rehospitalization rate and mortality rate were observed and compared between the two groups of neonates.RESULTS The utilization rate of antibiotics of the hospitalized neonates was significantly reduced after the antibiotics application strategies were changed(P<0.05).There was no significant difference in the cure rate or cure time between the two groups.The probiotics counts of the study group were significantly less than those of the control group after the neonates were treated with antibiotics for 1 week(P<0.05).CONCLUSION The risk assessment combined with surveillance and screening of infection may significantly reduce the utilization rate of antibiotics of the hospitalized neonates and may not have adverse effect on the neonates.