北京市部分医院门、急诊经验性选择抗生素调查分析

Survey and Analysis of Empirical Uses of Antibiotics in Out-patient Department and Emergency Room in Part of Hospitals in Beijing

目的 :了解北京市部分医院门、急诊常见感染抗生素的选择。方法 :采用问卷的方法调查北京协和医院、北京友谊医院、北京天坛医院、北京大学附属第三医院、解放军第 30 1医院等 15家医院教授 (A组 )、主治医师 (B组 )、住院医师 (C组 )、进修医师(D组 )对 3种常见门、急诊感染 (急性膀胱炎、急性上呼吸道感染、急性细菌性肠炎 )的抗生素选择 ,并对结果作统计学分析。结果 :共收到北京协和医院问卷 16 1份 ,收到其他医院 32 3份。急性上呼吸道感染 ,青霉素类和加 β-内酰胺酶抑制剂的青霉素类几乎占所有抗生素的 5 0 %以上。A组 ,协和医院选择第 2代头孢菌素比例高 ,而其他医院选择加酶抑制剂青霉素类的比例较高 (P<0 0 5 ) ;B组 ,协和医院选择大环内酯类抗生素占第 1位 ,与其它医院有显著性差异 (P <0 0 5 ) ;选择氟喹诺酮类抗生素者均少。急性膀胱炎 ,氟喹诺酮抗生素是各组的首选 ,协和医院A组甚至达到了 10 0 % ,与其它医院 (6 1 1% )比较 ,有显著性差异 (P <0 0 5 )。急性细菌性肠炎 ,选择氟喹诺酮和氨基糖苷抗生素的比例在各组均达到 90 %以上。与急性膀胱炎相似 ,协和医院医师更偏向于氟喹诺酮 (氟喹酮类 氨基糖苷类 =2 1) ,而其他医院选择氟喹诺酮和氨基糖苷类抗生素的比例接近 1∶1。结论

OBJECTIVE: To investigate the choice of antibiotics in common bacterial infections in both out-patient department and emergency room in pant of hospitals in Beijing. METHODS: Questionnaires about antibiotic choice of three kinds of infections (acute upper respiratory tract infection, acute cystitis, acute bacterial enteritis) were given to the physicians of Peking Union Medical College Hospital(PUMCH), and other 14 hospitals in Beijing. RESULTS: One hundred and sixty-one questionnaires from PUMCH and 323 from other hospitals were received. In acute upper respiratory tract infection, the percentage of choice of penicillin, amoxicillin and amoxicillin/clavulanic acid was over 50%. Professors in PUMCH preferred second generation cephalosporins, while professors in other hospitals preferred amoxicillin/clavulanic acid. Attending physicians in PUMCH took the macrolide as the first choice, which was significantly different from other hospitals ( P <0.05). Only 4 doctors in PUMCH and 2 doctors in other hospitals chose fluoroquinolone to treat acute respiratory tract infection. In acute cystitis, fluoroquinolone was the first choice in each group of doctors; the percentage even reached 100% in professors of PUMCH. In acute bacterial enteritis, the choice of fluoroquinolone and aminoglycoside was over 90%. Similar to acute cystitis, doctors in PUMCH preferred fluoroquinolones to aminoglycosides (fluoroquinolones/aminoglycosides=2/1), while in other hospitals , the rate was 1∶1. CONCLUSION: (1) In acute upper respiratory tract infection, most doctors choose beta-lactams first, macrolides is the second one, while few choose fluoroquinolone. (2) The high percentage of choice of fluoroquinolone in acute cystitis and acute enteritis is contradictory to the high quinolone resistance rate in E coli. (3) Prospective, randomized, case-controlled clinical trials should be made to help us lay out the guidelines of antibiotic usage in China.