新生儿重症监护室控制抗菌药物应用前后抗生素应用合理性调查
发布时间：2018-11-19 21:35
【摘要】：目的:探讨控制抗菌药物应用对新生儿重症监护室抗生素应用合理性的影响。方法:对我院新生儿一病区重症监护室(NICU)于2010年6月(控制前)与2015年6月(控制后)出院的患儿91例及101例的临床资料进行回顾性研究。对抗生素使用情况以改良CDC 12-Step标准进行分析评估。对患儿的一般资料、临床资料和抗生素使用情况进行分析。不合理使用的抗生素疗程按抗生素种类、使用天数、改良CDC 12-Step标准进行分析。结果:(1)控制前抗生素疗程中位数为14天(7-23天),控制后抗生素疗程中位数为16.5天(6-24天),两组比较差异无统计学意义(Z=0.251,P0.05)。(2)控制前有69(67%)个疗程、406(22%)个抗生素使用日被认为是不合理的。控制后组有56(49%)个疗程、357(18%)个抗生素使用日被认为是不合理的。两组比较均有统计学差异(x~2值分别为5.711和15.018,P均0.05)。(3)控制前初期使用抗生素不合理疗程比例为25%(26/103),持续使用抗生素不合理疗程比例为47%(36/76);控制后疗程初期抗生素不合理疗程比例为25%(28/114),持续使用抗生素不合理疗程比例为56%(55/99)。持续使用抗生素不合理比例均大于初期使用抗生素不合理比例(控制前后x~2值分别为9.456和21.402,P0.05)。(4)控制前、后“及时停用抗生素”不合理比例分别为48%和57%,两组比较有统计学差异(x~2=6.274,P0.05);“知道对广谱抗生素‘说不’”这一项目的不合理比例分别为27%和19%,两组比较有统计学差异(x~2=6.005,P0.05)。(5)抗菌药物控制前最常使用的抗生素是头孢西丁(729天),其中138天(19%)是不合理的;抗菌药物控制后最常使用的抗生素是青霉素(645天),其中109天(17%)是不合理的。结论:抗菌药物控制后抗生素使用合理性有所改善。但在持续使用抗生素时不合理情况仍然严重。抗菌药物控制前、后对“及时停用抗生素”标准都执行不好。在使用抗生素时,应密切关注新生儿的临床体征的变化,随访感染生化指标,有停药指征后应立即停用抗生素。同时,应注意避免对第三代头孢菌素的滥用。
[Abstract]:Objective: to investigate the effect of antimicrobial control on the rationality of antibiotic application in neonatal intensive care unit (NICU). Methods: the clinical data of 91 cases and 101 cases of neonatal intensive care unit (NICU) discharged from hospital in June 2010 (before control) and June 2015 (after control) were retrospectively studied. Use of antibiotics to improve the CDC 12-Step standard was analyzed and evaluated. The general data, clinical data and antibiotic use of children were analyzed. The course of irrational use of antibiotics was analyzed according to the types of antibiotics, the days of use and the modified CDC 12-Step criteria. Results: (1) the median course of antibiotic treatment was 14 days (7-23 days) before control and 16.5 days (6-24 days) after control. P0.05). (2) there were 69 (67%) courses of treatment before control, and 406 (22%) days of antibiotic use were considered unreasonable. After control, 56 (49%) courses and 357 (18%) days of antibiotic use were considered unreasonable. There was statistical difference between the two groups (x2 was 5.711 and 15.018). (3, respectively). The rate of irrational course of treatment before control was 25% (26 / 103). The rate of continuous use of antibiotics was 47% (36 / 76). The rate of irrational antibiotic treatment was 25% (28 / 114) at the initial stage of the controlled course and 56% (55 / 99) on the continuous use of antibiotics. The irrational proportion of continuous use of antibiotics was higher than that of initial use of antibiotics (x2 was 9.456 and 21.402). (4 respectively before and after control) before and after control. The unreasonable proportion of "stop antibiotics in time" was 48% and 57% respectively, there was statistical difference between the two groups (P 0.05). The irrational rates of "know to say no" to broad-spectrum antibiotics were 27% and 19%, respectively. There was a statistical difference between the two groups. P0.05). (5) the most commonly used antibiotics before antimicrobial control were cefoxitin (729 days), of which 138th days (19%) were unreasonable; Penicillin (645 days) is the most commonly used antibiotic after antimicrobial control, of which 109 days (17%) are unreasonable. Conclusion: the rational use of antibiotics has been improved after the control of antimicrobial agents. However, the irrational use of antibiotics is still serious. Antimicrobial control before, after the "stop antibiotics in time" standard are not implemented well. When using antibiotics, we should pay close attention to the changes of clinical signs of newborns, follow up the biochemical indicators of infection, and stop antibiotics immediately after the indication of withdrawal. At the same time, attention should be paid to avoid the abuse of the third generation cephalosporins.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R722.1
[Abstract]:Objective: to investigate the effect of antimicrobial control on the rationality of antibiotic application in neonatal intensive care unit (NICU). Methods: the clinical data of 91 cases and 101 cases of neonatal intensive care unit (NICU) discharged from hospital in June 2010 (before control) and June 2015 (after control) were retrospectively studied. Use of antibiotics to improve the CDC 12-Step standard was analyzed and evaluated. The general data, clinical data and antibiotic use of children were analyzed. The course of irrational use of antibiotics was analyzed according to the types of antibiotics, the days of use and the modified CDC 12-Step criteria. Results: (1) the median course of antibiotic treatment was 14 days (7-23 days) before control and 16.5 days (6-24 days) after control. P0.05). (2) there were 69 (67%) courses of treatment before control, and 406 (22%) days of antibiotic use were considered unreasonable. After control, 56 (49%) courses and 357 (18%) days of antibiotic use were considered unreasonable. There was statistical difference between the two groups (x2 was 5.711 and 15.018). (3, respectively). The rate of irrational course of treatment before control was 25% (26 / 103). The rate of continuous use of antibiotics was 47% (36 / 76). The rate of irrational antibiotic treatment was 25% (28 / 114) at the initial stage of the controlled course and 56% (55 / 99) on the continuous use of antibiotics. The irrational proportion of continuous use of antibiotics was higher than that of initial use of antibiotics (x2 was 9.456 and 21.402). (4 respectively before and after control) before and after control. The unreasonable proportion of "stop antibiotics in time" was 48% and 57% respectively, there was statistical difference between the two groups (P 0.05). The irrational rates of "know to say no" to broad-spectrum antibiotics were 27% and 19%, respectively. There was a statistical difference between the two groups. P0.05). (5) the most commonly used antibiotics before antimicrobial control were cefoxitin (729 days), of which 138th days (19%) were unreasonable; Penicillin (645 days) is the most commonly used antibiotic after antimicrobial control, of which 109 days (17%) are unreasonable. Conclusion: the rational use of antibiotics has been improved after the control of antimicrobial agents. However, the irrational use of antibiotics is still serious. Antimicrobial control before, after the "stop antibiotics in time" standard are not implemented well. When using antibiotics, we should pay close attention to the changes of clinical signs of newborns, follow up the biochemical indicators of infection, and stop antibiotics immediately after the indication of withdrawal. At the same time, attention should be paid to avoid the abuse of the third generation cephalosporins.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R722.1
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