616例上海市新型冠状病毒肺炎病例抗菌药物应用分析

Use of antibacterial drugs in 616 COVID-19 patients in Shanghai

目的了解新型冠状病毒肺炎(Coronavirus disease 2019,COVID-19)患者治疗期间抗菌药物的使用情况,为COVID-19的治疗和抗菌药物的管理提供依据。方法回顾性分析2020年1月20日-2020年4月30日上海市公共卫生临床中心收治的616例COVID-19患者的临床资料,包括人口统计学资料、入院时间、出院时间、使用抗菌药物的种类、使用剂量和疗程等,所有患者均随访至出院。分析抗菌药物的使用率、抗菌药物使用强度(Antibiotics use density,AUD)和不同抗菌药物的使用情况。结果616例患者中轻型137例、普通型382例、重型79例、危重型18例。男性343例,平均(41.1±16.8)岁,中位住院天数为16(12,20)天;女性273例,平均(42.8±17.5)岁,中位住院天数为14(11,20)天。在所有患者中共有165例(26.8%)患者使用抗菌药物治疗,在轻型、普通型、重型和危重型各亚组中,抗菌药物使用率分别为4.3%、21.7%、73.4%和100.0%,使用率与临床分型密切相关。住院患者抗菌药物整体使用率随着月份增加逐渐下降,普通型患者中3、4月份抗菌药物使用率低于1、2月份。所有患者的AUD为25.3,随着临床分型加重,各亚组的AUD逐渐升高(0.9、11.9、46.2和143.8)。在总体、轻型和普通型亚组患者中,1、2、3、4月份的AUD逐渐下降。抗菌药物使用总频次为286次,使用频率最高的前5类药物依次为氟喹诺酮类、β-内酰胺类/β-内酰胺酶抑制剂、碳青霉烯类、头孢菌素类、万古霉素和利奈唑胺。在重型患者中所使用的抗菌药物以限制使用级为主,在危重型患者中以特殊使用级为主。结论在COVID-19患者的治疗过程中,抗菌药物的使用率和AUD与临床分型相关;随着对COVID-19的认识和了解不断加深,本研究对抗菌药物的使用率和使用策略也在不断调整,以尽可能避免盲目或不恰当地使用抗菌药物。

OBJECTIVE To analyze the use of antibiotics in patients with coronavirus disease 2019(COVID-19)in Shanghai and to provide evidence for the treatment of COVID-19 and the management of antibacterial drugs.METHODS The clinical data of 616 patients with COVID-19 in Shanghai Public Health Clinical Center from 20 th,Jan.2020 to 30 th Apr.,2020 were collected retrospectively,including demographic data,time of admission,time of discharge,and use of antibacterial drugs.All patients were followed up until they were discharged.The frequency of antibacterial drug usage,AUD and the situation of antibacterial using were analyzed.RESULTS Among 616 patients,137 were mild,382 were common,79 were severe and 18 were critical severe.There were 343 males with an average age of 41.1 years and a median length of stay of 16 days,273 female cases with an average age of 42.8 years and a median length of stay of 14 days.A total of 165 patients(26.8%)received antibiotics therapy.The usage rates of antibiotics in the mild,common,severe and critical severe subgroups were 4.3%,21.7%,73.4%and 100.0%,respectively,which was closely related to clinical classification.The overall usage rates of antibacterial drugs in hospitalized patients gradually decreased with the increase of months.In common patients,the usage rates of antibacterial drugs in March and April were significantly lower than that in January and February.The AUD in all patients was 25.3.As the clinical classification worsened,the AUD in each subgroup gradually increased(0.9,11.9,46.2,and 143.8).In total,mild and common patients,the AUD showed a downward trend in January,February,March and April.The total frequency of antibacterial drugs was 286 times,and the top 5 most frequently used drugs were fluoroquinolones,β-lactamase/β-lactamase inhibitors,carbapenems,cephalosporins,and linezolid.In severe patients,the antibacterial drugs were mainly restricted use grade antibiotics,and in critical severe patients were mainly special use grade antibiotics.CONCLUSION In the treatment of COVID-19 patients,the usage rates of antibacterial drugs and AUD were related to clinical classification.As our knowledge and understanding of COVID-19 deepen,our usage rates and strategies of antibacterial drugs are being adjusted,in order to avoid inappropriate use of antibacterial drugs as much as possible.