抗菌药物科学化管理模式在儿童急性中耳炎诊治管理中的作用与效果

The effect of antimicrobial stewardship in the administration and treatment of acute otitis media in children

目的分析抗菌药物科学化管理(antimicrobial stewardship,AMS)模式在儿童急性中耳炎(acute otitis media,AOM)诊治中的作用及效果。方法选取2016年1月至2019年12月就诊于复旦大学附属儿科医院眼耳鼻喉科的54 980例AOM患儿作为研究对象,将2016年1月至2017年12月就诊的26 490例患儿作为AMS前组,接受常规治疗;2018年1月至2019年12月就诊的28 490例患儿作为AMS后组,接受AMS干预。AMS实施后,明确中耳炎的治疗方案为:首选青霉素,治疗5 d后评估效果,若无效换用三代头孢;若首选二代头孢,则治疗3 d评估效果,无效则换用青霉素,观察5 d评估效果,若还是无效,再换用三代头孢。通过回顾性对比、分析实施AMS前、后我院AOM患儿抗菌药物使用率、常用抗菌药物种类及细菌谱等。结果实施AMS后,我院AOM患儿门诊、住院的人均总费用、人均抗菌药物费用均明显降低(P<0.05);门诊抗菌药物使用率与实施前相比从28.51%降至22.22%;住院抗菌药物使用率降至53.32%(P<0.01)。应用抗菌药物疗程从(8.42±2.67)d缩短至(6.45±2.09)d;大环内脂类使用比例均降低(P<0.05)。实施AMS后,病原学送检率从0%提升至2.06%。送检587例患儿分中耳分泌物病原学标本中,培养阳性170例(28.96%)。其中,占比最高的为金黄色葡萄球菌(52.94%),其次是铜绿假单胞菌(18.82%)、卡他布兰汉菌(16.47%)、肺炎链球菌(9.40%)及近平滑假丝酵母菌(2.37%)。结论实施AMS模式可有效减少AOM患儿抗菌药物的不合理使用,实现抗菌药物科学化、规范化及常态化管理。

Objective To analyze the role of scientific antimicrobial management(AMS) model in the diagnosis and treatment of acute otitis media(AOM) in children.Methods From January 2016 to December 2019,54 980 cases of AOM children in the department of ophthalmology,otolaryngology,affiliated pediatric hospital of Fudan university were selected as the research objects.26 490 cases from January 2016 to December 2017 were selected as the pre AMS group and received routine treatment.28 490 cases from January 2018 to December 2019 were selected as the back group of AMS and received AMS intervention.After the implementation of AMS,the treatment plan of otitis media was determined as follows:penicillin was the first choice,and the effect was evaluated after 5 days of treatment,if the second generation cephalosporin was preferred,the effect was evaluated after 3 days of treatment,if the second generation cephalosporin was preferred,the effect was evaluated after 3 days of treatment,if it was still ineffective,the third generation cephalosporin was used.Through retrospective comparison and analysis of the utilization rate of antibacterials,the types of commonly used antibacterials and bacterial spectrum of AOM children in our hospital before and after the implementation of AMS.Results After the implementation of AMS,the costs of outpatient and inpatient per capita of patients with AOM in our hospital were significantly reduced(P<0.05).The use rate of antibacterial drugs in outpatient clinics was reduced from 28.51% to 22.22%,and the use rate of antibacterial drugs in hospitals was reduced to 53.32%(P<0.01).The duration of antibacterials treatment was shortened from(8.42±2.67)d to(6.45±2.09)d.The proportion of macrolide antibacterials was significantly reduced.After the implementation of AMS,the pathogen detection rate increased from 0% to 2.06%.In 587 cases of children,170 cases(28.96%) were culture positive.Among them,Staphylococcus aureus accounted for the highest proportion(52.94%),followed by Pseudomonas aeruginosa(18.82%),Bacillus catarrhalis(16.47%),Streptococcus pneumoniae(9.40%) and Candida parapsilosis (2.37%).Conclusion The scientific management mode of antibacterial drugs effectively reduces the unreasonable use of antibacterial drugs in children with AOM,and realizes the scientific,standardized and normal management of antibacterial drugs.