抗生素不合理使用状况的调查分析

Investigation and analysis of irrational use of antibiotics

目的:调查分析抗生素不合理使用状况。方法:将2013年4月至2014年9月梅州市五华县中医医院收治的392例住院患者作为研究对象,分析患者抗生素使用情况、细菌培养及药敏情况、院内感染发生情况等。结果:(1)抗生素使用情况:①使用率:392例患者中使用抗生素治疗者235例,抗生素使用率为59.9%;②使用种类:使用抗生素包括头孢菌素类、青霉素类、喹诺酮类、抗病毒药物、抗真菌类、氨基糖苷类、β内酰胺类、大环内酯类、植物类、硝咪唑类、抗结核类、四环紊类,使用率依次为40.0%、32.8%、22.6%、16.2%、11.5%、9.4%、7.7%、7.2%、6.0%、4.7%、2.6%、0.9%;③联合使用情况:以单用一种抗生素最为常见(48.9%),其次是两种抗生素联用(41.7%)、3种抗生素联用(8.5%)、4种抗生素联用(0.9%);④使用科室排名:依次是妇科、外科、儿科、耳鼻喉科、内科、眼科;⑤使用依据:经验用药者205例(87.2%);细菌培养后用药30例(12.8%),两者比较,差异有统计学意义(P<0.05)。(2)细菌培养结果:30例细菌培养中阳性28例(93.3%);共培养出62株病原菌,其中包括革兰阳性菌30株(48.4%)、革兰阴性菌21株(33.9%)、真菌11株(17.7%)。(3)药敏情况:革兰阳性菌主要对青霉素、苯唑西林、红霉素、克林霉素、多西环素、头孢西丁、左氧氟沙星、庆大霉素等抗生素具有耐药性;革兰阴性菌主要对青霉素、氨苄西林、哌拉西林、阿莫西林、红霉素、四环素、庆大霉素等抗生素具有耐药性;真菌主要对益康唑、咪康唑、伊曲康唑等抗生素具有耐药性。(4)院内感染发生情况:235例患者中2例发生院内感染,发生率为0.9%;3例治疗期间出现发热、皮肤瘙痒、头晕等不良反应,停药并给予对症处理后症状均改善。结论:调查并分析抗生素不合理使用状况,有助于指导临床抗生素的合理使用,继而促进治疗效果,提升用药安全性。

Objective:To investigate the irrational use of antibiotics.Methods:A total of 392 inpatients admitted to Wuhua County Hospital of Traditional Chinese Medicine in Meizhou between April 2013 and September 2014 were included as the subjects in the study.The antibiotic use,bacterial culture,drug sensitivity,and the incidence of nosocomial infection were determined.Results:(1)Antibiotic use:①Usage rate:Among392 patients,235 patients were treated with antibiotics,and the rate of antibiotic use was 59.9;②Categories of use:The antibiotics involved Cephalosporins,Penicillins,Quinolones,antiviral drugs,antifungal drugs,Aminoglycosides,ΒLactams,Macrolides,plants,Nitroimidazoles,antitubercular drugs,and Tetracyclines.The usage rates of the antibiotics were 40.0%,32.8%,22.6%,16.2%,11.5%,9.4%,7.7%,7.2%,6.0%,4.7%,2.6%,and 0.9%,respectively.③Joint use:Using one antibiotic alone was the most common(48.9%),followed by joint use of two antibiotics(41.7%),three antibiotics(8.5%)and four antibiotics(0.9%).④The usage ranking in departments:Department of Gynecology,Department of Surgery,Department of Pediatrics,Department of Otolaryngology,Department of Internal Medicine,Department of Ophthalmology.⑤Evidence for use:There were 205 cases of empirical medication(87.2%),and 30 cases of medication after bacterial culture(12.8%),with statistically significant difference(P<0.05).(2)Results of bacterial culture:Among 30 cases of bacterial culture,28(93.3%)were positive.Sixty-two pathogenic bacteria were cultured,including 30 strains of Grampositive bacteria(48.4%),21 of Gram-negative bacteria(33.9%)and 11 of fungi(17.7%).(3)Drug sensitivity:Gram-positive bacteria were mainly resistant to antibiotics such as Penicillin,Oxacillin,Erythromycin,Clindamycin,Doxycycline,Cefoxitin,Levofloxacin,and Gentamicin oxacillin;Gram-negative bacteria were mainly resistant to antibiotics such as Penicillin,Ampicillin,Piperacillin,Amoxicillin,Erythromycin,Tetracycline,and Gentamicin.Fungi were mainly resistant to antibiotics such as Econazole,Miconazole and Itraconazole.(4)Occurrence of nosocomial infection:Among 235 patients,there were 2 cases of nosocomial infection,and the incidence rate was 0.9.Adverse reactions such as fever,pruritus,and dizziness occurred in 3 cases during the treatment,and the symptoms were improved by symptomatic treatment after drug withdrawal.Conclusion:Investigating and analyzing the irrational use of antibiotics is useful for guiding the rational use of clinical antibiotics,and thereby promote the therapeutic effect and improve the safety of medication.