福建医科大学附属泉州第一医院儿科患者碳青霉烯类抗生素临床合理用药分析

Analysis of clinical rational use of carbapenem antibiotics in pediatric patients in a general hospital

目的评价福建医科大学附属泉州第一医院儿科住院患者碳青霉烯类抗生素的临床合理应用情况。方法回顾性分析2018年儿科96例患者碳青霉烯类抗生素的用药情况。结果共点评96例患者,男68例,女28例,中位年龄(四分位距)1.00(4.95)岁,中位体重(四分位距)9.00(17.33)kg;微生物送检94例,送检率为97.92%;细菌培养阳性32例,阳性率34.04%,分离菌株主要来源于静脉血和痰液,占70.00%;碳青霉烯类药物的中位用药天数(四分位距)为8.00(8.75)d。综合评价100分85例,90分3例,80分2例,0分6例。扣分项目包括适应证不符合,用法用量及配伍不当,使用抗菌药物前无相应的病原学检查,以及治疗过程中缺乏对疗效进行评估的动态实验室检查等。结论该院儿科住院患者碳青霉烯类抗生素应用基本合理,但临床科室需严格控制碳青霉烯类在感染患儿中的应用,强调病原学诊断,尽早实施目标性治疗。还应积极开展合理用药专项点评和临床培训,规范碳青霉烯类抗生素的应用。

Objective To evaluate the clinical rational use of carbapenem antibiotics in hospitalized pediatric patients in the Affiliated Quanzhou First Hospital of Fujian Medical University.Methods A retrospective analysis was conducted in pediatric patients who received carbapenem antibiotics in 2018 to examine rationality of carbapenem use.Results A total of 96 patients were enrolled,including 68 males and 28 females,with a median age(interquartile range,IQR)of 1.00(4.95)years,and a median weight(IQR)of 9.00(17.33)kg.Samples were submitted for microbiological testing in 94 cases(97.92%).Bacterial culture was positive in 32 cases(34.04%).The bacterial strains were mainly isolated from blood and sputum,accounting for 70.00%.The median(IQR)duration of carbapenem treatment was 8.00(8.75)days.The rationality of carbapenem use was rated in a 100-point scoring system.The result showed 100 points in 85 cases,90 points in 3 cases,80 points in 2 cases,and 0 points in 6 cases.The main demerit points included incorrect indications,inappropriate dosage and incompatibility,no etiological examination before antibiotic therapy,and lack of dynamic laboratory tests to evaluate the efficacy during treatment.Conclusions The use of carbapenem antibiotics is generally reasonable in hospitalized pediatrics,but carbapenem use should be strictly controlled in clinical practice and limited to the children with infection.It is important to clarify etiological diagnosis,and implement targeted therapy as soon as possible.It is also necessary to actively carry out special comments and clinical training in rational antibiotic use so as to standardize the use of carbapenem antibiotics.