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抗菌药物临床应用控制对新生儿血源性感染的影响

发布时间:2018-03-05 20:39

  本文选题:新生儿 切入点:血源性感染 出处:《重庆医科大学》2014年硕士论文 论文类型:学位论文


【摘要】:目的:探讨抗菌药物临床应用控制对新生儿血源性感染病原学及临床特点的影响,发现抗菌药物控制执行过程中的问题及其带来的利弊,为制定进一步的抗菌药物用药规范提供依据。 方法:以2010年(控制前组)和2013年(控制后组)我院新生儿病房所有患者为总体研究对象。出院诊断为确诊或疑诊新生儿败血症、化脓性脑膜炎、急性血源性骨髓炎(以下统称 血源性感染‖)的病例分别有542例和1239例,按照《实用新生儿学》第四版、《小儿外科学》第四版(人民卫生出版社)中的诊断标准进行重新评估,将确诊病例纳入研究,分别有168例和470例,对其临床资料进行回顾性研究。 结果:1.2010年、2013年新生儿病房所有病例总体情况:①2013年病房共收治患者7265例,2010年共收治患者6045例,血源性感染收治率2013年(6.47%)较2010年(2.78%)升高(P0.01)。②血源性院内感染发生率2013年(0.70%)较2010年(0.30%)升高(P=0.001)。③抗菌药物使用率2013年(79.25%)较2010年(91.83%)显著降低(P<0.01);抗菌药物使用强度2013年(8.37)较2010年(10.65)降低。2.2010年、2013年血源性感染病例情况:①革兰阳性菌感染率2013年(52.08%)较2010年(75.32%)降低(P=0.001);革兰阴性菌、真菌感染率2013年(40.97%、6.94%)均较2010年(24.68%、0.00%)升高(P=0.016,P=0.018)。②两组血培养检出率前四位病原菌均为溶血葡萄球菌、表皮葡萄球菌、肺炎克雷伯菌肺炎亚种、大肠埃希氏菌,四种细菌的MRS、β-内酰胺酶阳性、ESBL阳性等耐药情况无统计学差异(P0.05)。③青霉素类、头孢菌素类第一二代、三四代使用率2013年(73.62%、21.28%、39.79%)较2010年(92.86%、75%、53.57%)显著降低(P<0.01);碳青霉烯类使用率2013年(35.74%)较2010年(16.07%)升高(P<0.01);两组糖肽类使用率比较无统计学差异(P=0.261)。④2013年抗菌药物联用以单用为主(59.87%),2010年以二联为主(85.71%),,两组比较有统计学差异(P0.01)。⑤抗菌药物更换次数2013年(0.83±1.037)较2010年(1.07±1.135)减少(P=0.013)。⑥抗菌药物使用天数2013年(15.45±13.36)较2010年(12.12±10.7)增加(P=0.001)。⑦两组出院转归比较无统计学差异(P0.05)。⑧平均住院天数2013年(16.08±14.345)较2010年(11.96±12.356)增加(P0.01)。 结论:我院新生儿病房自2012年8月起正式实施抗菌药物临床应用控制方案,2013年抗菌药物的使用率、使用强度均较2010年下降;对于血源性感染,最常见病原菌及其耐药情况无显著变化,抗菌药物的更换次数、联用情况有显著改善,血源性院内感染发生率升高,但未增加患儿病情恢复不良的风险。
[Abstract]:Objective: to explore the effect of clinical application control of antimicrobial agents on the etiology and clinical characteristics of neonatal hematogenous infection, and to find out the problems and advantages and disadvantages in the process of carrying out the control of antimicrobial agents. To provide a basis for the formulation of further antimicrobial drug use norms. Methods: all the patients in the neonatal wards of our hospital on 2010 (before control) and 2013 (after control) were selected as the general subjects. The patients were diagnosed as septicemia or suppurative meningitis. There were 542 cases of acute hematogenous osteomyelitis (hereinafter referred to as hematogenous infection) and 1239 cases of acute hematogenous osteomyelitis, According to the diagnostic criteria in 4th edition of practical Neonatology and 4th Edition of Pediatric surgery (people's Health Publishing House), the confirmed cases were included in the study, 168 cases and 470 cases, respectively. The clinical data were retrospectively studied. Results: 1. In 2010, in 2013, all the cases in neonatal ward were as follows: 1 in 2013, 7265 cases were admitted in ward, and 6045 cases were admitted in 2010. The incidence of hematogenous nosocomial infection in 2013 (6.47) was significantly higher than that in 2010 (2.78)) the incidence of hematogenous nosocomial infection was increased in 2013 (0.70) and in 2013 (0.30).) the utilization rate of antimicrobial agents in #datea- 79.25.3) was significantly lower than that in #datem91.83C (P < 0.01); the intensity of antimicrobial use in #date6 # / 8.37) was significantly lower than that in 2013 (8.37). In 2013, the infection rate of Gram-positive bacteria (52.08) was lower than that of 2010 (75.32). (2.The infection rate of Gram-positive bacteria in 2013 was lower than that in 2010 (75.32), and the rate of Gram-negative bacteria was lower than that of 2010 (P < 0.05). The infection rate of fungi in 2013 was higher than that in 2010 (24.68).) the first four pathogens were Staphylococcus haemolyticus, Staphylococcus epidermidis, Klebsiella pneumoniae pneumonia subspecies, Escherichia coli in the two groups, and the first four pathogens were Staphylococcus haemolyticus, Staphylococcus epidermidis, Klebsiella pneumoniae pneumonia subspecies, Escherichia coli. There was no significant difference in resistance to MRS, 尾 -lactamase positive ESBL among the four bacteria (P0.053.penicillin, cephalosporins for 12th generations). The utilization rate of the third and fourth generations in 2013 was significantly lower than that in 2010 (92.86775 and 53.57); the utilization rate of carbapenems was 35.74g (2013) higher than that of 2013 (16.07); there was no statistical difference between the two groups in the utilization rate of glycopeptide (P 0.261 1). 4in 2013, the combination of antimicrobial agents was mainly used alone (59.87%), and the usage rate of carbapenem was higher than that of 2013 (16.07 7); there was no statistical difference between the two groups in the utilization rate of glycopeptide (P < 0.01). There was a significant difference between the two groups in the number of antimicrobial drug changes (0.83 卤1.037 on 2013) and 1.07 卤1.135 on 2010 (P < 0.013.6). The number of days used with antimicrobial agents decreased in 2013 (15.45 卤13.36) than in 2013 (12.12 卤10.7). There was no statistical difference between the two groups in the outcome of discharge. There was no statistical difference between the two groups in the average hospitalization days (P 0.05.8). The number on 2013 was 16.08 卤14.345), which was higher than that on 2010 (11.96 卤12.356). Conclusion: the clinical application control scheme of antimicrobial agents has been implemented since August 2012 in neonatal wards of our hospital. The utilization rate and intensity of antibiotics in 2013 were lower than those in 2010. There was no significant change in the most common pathogens and their drug resistance. The frequency of change of antibiotics and the combined use of antibiotics were significantly improved. The incidence of hematogenous nosocomial infection was increased, but the risk of poor recovery was not increased.
【学位授予单位】:重庆医科大学
【学位级别】:硕士
【学位授予年份】:2014
【分类号】:R722.1

【参考文献】

相关期刊论文 前2条

1 俞刚;张肖;沈静;陈瑜;严佳斌;颜承靖;;耐碳青霉烯类肠杆菌科细菌KPC和NDM-1β内酰胺酶耐药基因的研究[J];中国感染与化疗杂志;2014年01期

2 胡志军;张盛;潘晓龙;朱娟娟;潘恺;唐吉斌;周东升;;2012年铜陵市人民医院细菌耐药性监测[J];中国感染与化疗杂志;2014年01期



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