云南省玉溪市红塔区伤寒、副伤寒疾病负担研究

发布时间：2018-02-25 17:41

本文关键词： 伤寒副伤寒疾病负担　出处：《中国疾病预防控制中心》2010年硕士论文　论文类型：学位论文

【摘要】：目的：利用云南玉溪市红塔区伤寒、副伤寒高发地区综合干预示范项目发热监测系统收集的信息,估计疾病负担,为开展综合干预,制定符合当地实际情况的伤寒、副伤寒防治策略提供依据。方法：1.根据疾病疾病负担估计金字塔模型,调查红塔区的发热病人就诊率(A),就诊病人采样率(B),样本检测率(C),检测方法灵敏度(D)和实验室确诊病例报告率(E),计算倍数,以此来校正监测系统2008年5月1日至2009年4月30日一年内的实验室确诊病例数据,估算当地的发病水平。2.问卷调查红塔区副伤寒病人各项经济负担,估算分年龄组和全人群经济负担。3.调查三家市级医院住院病人抗生素使用及耐药状况,按是否使用耐药抗生素分为耐药组和非耐药组,分析抗生素耐药对疾病经济负担的影响。结果：1.共报告实验室确诊副伤寒病例354例,估计红塔区副伤寒年总发病数为965例(745-2284例),年发病率为220.33/10万(170.1-521.47)。发病率最高的年龄组为15-44岁组(318.27/10万),最低的为0-4岁组(18.12/10万)。2.红塔区副伤寒造成的直接经济成本为2197222元(1694833-5201962),间接经济成本为229230元(177120～540540)。经济负担为2426452元(1871953-5742502)。3.按是否使用过自身分离菌株耐药的抗生素,119名住院病人被分成使用过耐药抗生素组(耐药组)和未使用过耐药抗生素组(非耐药组),耐药组包括23例曾使用过1种耐药抗生素的住院病例,和1例曾使用过2种耐药抗生素的住院病例,共计24例。其中有12例使用的耐药抗生素为克林霉素,占48%,有7例使用的为阿莫西林,占28%,有3例使用的为氨苄西林,占12%,有2例使用的为氧氟沙星,占8%,有1例使用的为头孢噻肟,占4%。耐药组住院时间中位数为14天,抗生素费用中位数为1241.96元。其余95例未使用过耐药抗生素的住院病例进入非耐药组,住院时间中位数为14天,抗生素费用中位数为1365.02元。经统计检验,耐药组和非耐药组在住院时间(Z=-0.7014,P=0.4831)和抗生素费用(Z=-1.3212,P=0.1864)上的差异均无统计学意义。就此可以认为红塔区当前的抗生素耐药状况对副伤寒疾病经济负担没有影响。结论：1.红塔区为副伤寒高流行地区,副伤寒发病率为220.33(170.10～521.47)。2.红塔区副伤寒造成的经济负担约为2426452元(1871953～5742502)。3.抗生素耐药未对红塔区副伤寒造成的直接负产生影响。
[Abstract]:Objective: to estimate the burden of disease by using the information collected by the fever surveillance system of the comprehensive intervention demonstration project in Hongta District, Yuxi City, Yunnan Province, in order to formulate typhoid fever in accordance with the local actual conditions. Paratyphoid fever control strategy provides the basis. Method: 1. Estimate the pyramid model according to the disease burden, To investigate the rate of fever patients in Hongta district, the sampling rate of patients, the rate of sample detection, the sensitivity of detection method and the rate of laboratory confirmed case report were investigated, and the multiple was calculated. This is used to correct the data of laboratory confirmed cases from May 1st 2008 to April 30th 2009 in the surveillance system, and to estimate the local incidence level .2. to investigate the economic burden of paratyphoid fever patients in Hongta District. To estimate the economic burden of age group and the whole population. 3. To investigate the antibiotic use and drug resistance of inpatients in three municipal hospitals, and divide them into drug resistance group and non resistance group according to whether to use resistant antibiotics or not. The effect of antibiotic resistance on the economic burden of disease was analyzed. Results: a total of 354 laboratory confirmed paratyphoid fever cases were reported. It is estimated that the total annual incidence of paratyphoid fever in Hongta District is 965 cases or 745-2284 cases, and the annual incidence rate is 220.33 / 100 000 100.1-521.470.The highest incidence rate is 318.27% -100 000 in the 15-44 age group, and the lowest is 18.12% -100 000 in the 0-4 age group. The direct economic cost caused by paratyphoid fever in Hongta District is 2197222. The indirect economic cost was 229230 yuan / L 177120 / 5405400.The economic burden was 2426452 yuan / 1873 / 5742502N / 3.119 inpatients were divided into two groups according to whether or not they had used their own isolated strains of antibiotics (drug resistance group) or not (drug resistant group). The drug resistance group included 23 inpatients who had used a drug resistant antibiotic. And a total of 24 patients who had used two antibiotic resistant antibiotics, 12 of them used clindamycin (48%), 7 cases used amoxicillin (28%), 3 cases used ampicillin (ampicillin). There were 2 cases using ofloxacin (8 cases) and 1 case of cefotaxime (4%). The median hospitalization time of drug resistant group was 14 days. The median cost of antibiotics was 1241.96 yuan. The other 95 inpatients who had not used antibiotic resistance entered the non-resistant group. The median hospitalization time was 14 days and the median cost of antibiotics was 1365.02 yuan. There was no significant difference between the drug resistant group and the non-resistant group in the hospitalization time of ZHU -0.7014 PnP (0.4831) and the antibiotic cost (ZTX -1.3212P0. 1864). Therefore, it can be concluded that the current situation of antibiotic resistance has no effect on the economic burden of paratyphoid disease in Hongta District. Conclusion: 1) the current situation of antibiotic resistance has no effect on the economic burden of paratyphoid fever. Hongta District is a paratyphoid high endemic area, The incidence of paratyphoid fever was 220.33 / 170.10 / 521.471.2.The economic burden caused by paratyphoid fever in Hongta district was about 2426452 yuan. The antibiotic resistance had no direct negative effect on paratyphoid fever in Hongta district.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R516.3;R181.3

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