1349例肠道门诊患者院前抗菌药物使用情况调查

Investigation on antibacterial agents use among 1349 patients in enteric disease clinic before consultation

目的了解肠道门诊患者院前抗菌药物使用情况,以加强抗菌药物合理使用科普教育,促进抗菌药物的合理应用。方法选取2021年4月1日至10月31日就诊于北京大学第一医院肠道门诊的1349例患者,收集患者人口统计学特征、病程、临床表现、抗菌药物的使用、实验室检查结果,根据就诊前是否自行使用抗菌药物分为院前用过抗菌药物组(220例)和院前未用过抗菌药物组(1067例),分析就诊前使用抗菌药物组患者的临床特征,进一步分析其应用抗菌药物的合理性;计量资料比较采用t检验或非参数检验,计数资料比较采用χ^(2)检验。结果共入组1349例患者,其中男性681例(50.5%),女性668例(49.5%);平均年龄为(44.5±19.09)岁。220例(16.31%)患者就诊前已使用过抗菌药物,使用喹诺酮类患者最多(110例、50%),其次为头孢菌素类(49例、22.3%)和青霉素类(17例、7.7%)。院前使用过抗菌药物的220例患者中,119例(54.1%)临床不建议其使用抗菌药物。较院前未使用抗菌药物的患者,院前使用过抗菌药物的患者学历在大专及以上的比例高(77.6%vs.67.0%:χ^(2)=9.592、P=0.002),发病至就诊时间更长[34(16,55)h vs.24(10,50)h:Z=-3.935、P<0.001]、病程中最高体温更高[36.9(36.5,38.0)℃vs.36.7(36.5,37.2)℃:Z=-3.563、P<0.001]、腹泻次数更多[7(5,10)vs.5(4,8):Z=-4.464、P<0.001]。院前使用过抗菌药物组中建议使用抗菌药物患者较不建议使用抗菌药物者发病至就诊时间较短[29(12.5,44.5)h vs.44(18,74)h:Z=-2.945、P=0.003],最高体温较高[37.4(36.7,38.5)℃vs.36.7(36.4,37.0)℃:Z=-4.572、P<0.001],便白细胞计数较高[3(0,15)个/HP vs.0(0,0)个/HP:Z=-6.658、P<0.001],出现呕吐(28.7%vs.16.8%:χ^(2)=4.473、P=0.034)和发热(55.4%vs.22.7%:χ^(2)=24.951、P<0.001)比例较高。院前未使用抗菌药物组中建议使用抗菌药物患者较不建议使用抗菌药物者发病至就诊时间较短[19(8,37)h vs.26(11,56)h:Z=-4.331、P<0.001],最高体温较高[36.9(36.5,37.9)℃vs.36.6(36.5,37.0)℃:Z=-6.723、P<0.001],腹泻次数较多[6(4,10)vs.5(4,8):Z=-3.512、P=0.001],便白细胞计数较多[1(0,15)个/HP vs.0(0,0)个/HP:Z=-12.237、P<0.001],出现腹痛(70.4%vs.58.3%:χ^(2)=14.601、P<0.001)、恶心(48.4%vs.39.3%:χ^(2)=7.871、P=0.005)、发热(37.7%vs.16.5%:χ^(2)=58.642、P<0.001)和里急后重(25.8%vs.19.9%:χ^(2)=4.685、P=0.030)比例较高。发病至就诊时间<24 h患者较>24 h者最高体温较高[36.8(36.5,37.5)℃vs.36.6(36.4,37.0)℃:Z=-4.756、P<0.001],出现腹痛(66.2%vs.58.2%:χ^(2)=7.120、P=0.008)、恶心(50.8%vs.33.9%:χ^(2)=31.025、P<0.001)、呕吐(33.11%vs.13.9%:χ^(2)=54.867、P<0.001)、发热(28.6%vs.18.2%:χ^(2)=16.122、P<0.001)比例较高。发病至就诊时间<48 h组较>48 h者患者最高体温较高[36.8(36.5,37.4)℃vs.36.6(36.4,36.9)℃:Z=-4.847、P<0.001],出现腹痛(64.4%vs.56.4%:χ^(2)=5.660、P=0.017)、恶心(46.2%vs.31.8%:χ^(2)=17.820、P<0.001)、呕吐(28.3%vs.10.4%:χ^(2)=37.737、P<0.001)和发热(27.5%vs.12.1%:χ^(2)=28.019、P<0.001)比例较高。结论肠道门诊患者院前抗菌药物滥用现象仍存在,需将抗菌药物管理关口前移,可将高学历、中青年人群作为重点教育对象,强调腹泻次数多、体温高等并非抗菌药物适应证,病程长不能作为指导抗菌药物应用的标准。

Objective To investigate the prevalence of self-administered antibacterial agents use prior to medical consultation among patients in enteric disease clinic,and then take action to improve the education on appropriate antibacterial agents use and promote rational use of antibacterial agents.Methods Total of 1349 patients who attended enteric disease clinic of Peking University First Hospital from 1st April to 31st October,2021 were selected.General data such as demographic characteristics,disease course,clinical manifestations,use of antibacterial agents,and laboratory test results were collected.All patients were grouped according to whether they had used antibacterial agents before consultation to analyze the clinical characteristics of the population using antimicrobials drugs before consultation and assess the rationality of their use of antibacterial agents.The measurement data were analyzed by t test or non-parametric test,and the counting data was analyzed byχ^(2) test.Results Total of 1349 patients were enrolled,including 681 males(50.5%)and 668 females(49.5%).The average age was(44.5±19.09)years old.There were 220 patients(16.31%)who had used antibacterial agents before treatment,and quinolones(110 cases,50%)was the most,followed by cephalosporins(49 cases,22.3%)and penicillins(17 cases,7.7%).Among 220 cases who had used antibacterial agents before consultation,119 cases(54.1%)were not recommended to use antibacterial agents.Compared with patients who did not use antibacterial agents before treatment,patients who had used antibacterial agents before treatment had higher proportion of college education or above(77.6%vs.67.0%:χ^(2)=9.592,P=0.002),longer course of disease[34(16,55)h vs.24(10,50)h:Z=-3.935,P<0.001],higher maximum body temperature[36.9(36.5,38.0)℃vs.36.7(36.5,37.2)℃:Z=-3.563,P<0.001],and increased frequency of diarrhea[7(5,10)vs.5(4,8):Z=-4.464,P<0.001].Among patients who had used antibacterial agents before consultation,compared with cases who were not recommended to use antibacterial drugs,cases who recommended to use antibacterial drugs had shorter course of disease[29(12.5,44.5)h vs.44(18,74)h:Z=-2.945,P=0.003],higher maximum body temperature[37.4(36.7,38.5)℃vs.36.7(36.4,37.0)℃:Z=-4.572,P<0.001],elevated fecal white blood cell count[3(0,15)/HP vs.0(0,0)/HP:Z=-6.658,P<0.001],higher percentage of vomiting(28.7%vs.16.8%:χ^(2)=4.473,P=0.034)and higher percentage of fever(55.4%vs.22.7%:χ^(2)=24.951,P<0.001).Among patients who did not use antibacterial agents before consultation,compared with cases who were not recommended to use antibacterial drugs,cases who were recommended to use antibacterial drugs had shorter course of disease[19(8,37)h vs.26(11,56)h:Z=-4.331,P<0.001],higher maximum body temperature[36.9(36.5,37.9)℃vs.36.6(36.5,37.0)℃:Z=-6.723,P<0.001],increased incidence of diarrhea[6(4,10)vs.5(4,8):Z=-3.512,P=0.001],elevated fecal white blood cell count[1(0,15)/HP vs.0(0,0)/HP:Z=-12.237,P<0.001],higher percentage of abdominal pain(70.4%vs.58.3%:χ^(2)=14.601,P<0.001),nausea(48.4%vs.39.3%:χ^(2)=7.871,P=0.005),fever(37.7%vs.16.5%:χ^(2)=58.642,P<0.001)and tenesmus(25.8%vs.19.9%:χ^(2)=4.685,P=0.030).Compared with cases with course from onset to consultation>24 hours,patients with course from onset to consultation<24 hours had higher maximum body temperature[36.8(36.5,37.5)℃vs.36.6(36.4,37.0)℃:Z=-4.756,P<0.001],higher proportion of abdominal pain(66.2%vs.58.2%:χ^(2)=7.120,P=0.008),nausea(50.8%vs.33.9%:χ^(2)=31.025,P<0.001),vomiting(33.11%vs.13.9%:χ^(2)=54.867,P<0.001)and fever(28.6%vs.18.2%:χ^(2)=16.122,P<0.001).Compared with cases with course from onset to consultation>48 hours,patient with course from onset to consultation<48 hours had higher maximum body temperature[36.8(36.5,37.4)℃vs.36.6(36.4,36.9)℃:Z=-4.847,P<0.001],with higher proportion of abdominal pain(64.4%vs.56.4%:χ^(2)=5.660,P=0.017),nausea(46.2%vs.31.8%:χ^(2)=17.820,P<0.001),vomiting(28.3%vs.10.4%:χ^(2)=37.737,P<0.001),and fever(27.5%vs.12.1%:χ^(2)=28.019,P<0.001).Conclusions At present,pre-hospital antimicrobial drug abuse is still a serious phenomenon among patients in enteric disease clinic,and it is necessary to strengthen the management of antibiotics.The highly educated,middle-aged and young people can be taken as the key education targets,emphasizing that the frequency of diarrhea and high body temperature are not indications of antibacterial agents,and the long course of disease cannot be used as the standard to guide the application of antibiotics.