白细胞、C反应蛋白作为细菌感染指标在儿童社区获得性肺炎抗生素使用管理中的再探讨

Leukocytes and C-reactive protein as indicators of bacterial infection in the management of antibiotics for children with community-acquired pneumonia

目的比较白细胞及C反应蛋白数值与儿童社区获得性肺炎抗生素使用情况的关系,进一步探讨该两项指标在儿童社区获得性肺炎感染中作为经验性使用抗生素指征的实际意义。方法收集2014年1月-2018年12月汕头大学医学院第二附属医院儿童呼吸感染病区收住院的5720例社区获得性肺炎患儿临床资料,回顾性分析白细胞及C反应蛋白数值与抗生素使用之间的关系。结果5年间儿童获得性肺炎抗生素年平均使用率为57.9%。其中白细胞数值在<6×10^(9)/L、~10×10^(9)/L、~25×10^(9)/L和≥25×10^(9)/L各组中抗生素使用率分别为52.27%、52.69%、61.18%、89.90%;CRP数值在≤8 mg/L、~20 mg/L、~40 mg/L和>40 mg/L各组中抗生素使用率分别为48.54%、63.73%、82.86%、97.76%。结论一部分社区获得性肺炎患儿虽然出现白细胞及CRP升高,但综合判断其若为病毒感染导致者,仍可不需要使用抗生素。

Objective To compare the correlations of the values of white blood cells and C-reactive protein with the use of antibiotics in children with community-acquired pneumonia,and further explore the practical significance of these two indicators as empirical ones for the use of antibiotics in children with community-acquired pneumonia.Methods The clinical data of 5720 children with community-acquired pneumonia admitted to the Child Respiratory Infection Ward of the Second Affiliated Hospital of Shantou University Medical College from January 2014 to December 2018 were collected,and the correlations of the values of white blood cells and C-reactive protein with the use of antibiotics were retrospectively analyzed.Results The average annual use rate of antibiotics for community-acquired pneumonia in the children’s respiratory infection areas was 57.9%during the five years.The white blood cell values in<6×10^(9)/L group,~10×10^(9)/L group,~25×10^(9)/L group,≥25×10^(9)/L group,the antibiotic usage rate of the group were 52.27%,52.69%,61.18%,89.90%,respectively.The CRP values in the≤8 mg/L group,~20 mg/L group,~40 mg/L group,>40 mg/L group,the antibiotic usage rates were 48.54%,63.73%,82.86%,and 97.76%,respectively.Conclusion In spite of elevated white blood cells and CRP in those with community-acquired pneumonia,some children still do not need antibiotics even if they are comprehensively diagnosed with viral infection.