山东省农村居民抗生素耐药现状及影响因素研究

发布时间：2018-05-09 14:12

本文选题：抗生素耐药性 + 农村居民　；参考：《山东大学》2014年硕士论文

【摘要】：研究背景自上个世纪40年代青霉素问世以来,抗生素的应用给细菌感染的治疗带来了革命性的改变,但随着抗生素的广泛应用,其不合理使用的问题也越来越严重,部分细菌逐渐对抗生素类药物产生耐药性,加重了患者的医疗负担。我国的抗生素耐药率正在逐年升高,而目前国内关于抗生素不合理使用和耐药机制的研究,更多的是从临床的角度出发,研究医疗机构患者的细菌耐药情况,很少有研究从人群的角度出发,研究卫生服务提供者和消费者的认知和行为与抗生素使用和耐药菌产生之间的关系。农村地区是我国抗生素滥用的重灾区,而关于农村健康人群中抗生素耐药流行程度的研究几乎没有。因此,本研究将通过评估山东省农村居民抗生素不合理使用和细菌耐药的程度来为相关监测体系的建立提供科学依据。研究目的本研究的目的是通过检测农村居民携带超广谱p-内酰胺酶(ESBL)的情况来评估农村地区抗生素耐药的流行程度,并通过分析农村居民和医生对抗生素使用的认知和行为来探索影响农村地区抗生素使用和耐药流行的相关因素,为促进农村地区抗生素合理使用,提高居民健康水平提供合理建议。研究方法根据地理位置和经济发展水平在山东省抽取了阳谷、宁阳和胶南3个县(市),每个县选取3个镇,每镇选取2个村进行调查。在每个村对60名农村居民进行了问卷调查和粪便标本的收集,在每个被调查的县、镇、村均进行了医疗机构门诊处方资料的收集和医生问卷的调查。收集1014份农村居民问卷,1035份粪便标本,问卷与标本相匹配者共1000份将被纳入本研究的分析。共收集了188份医生问卷,10676份张门诊处方。采用Epidata3.1建立数据库进行数据录入,在Excel2007中对数据进行整理和完善,使用SPSS17.0对数据进行描述性分析和统计推断,统计方法主要是卡方检验和二元Logistic回归分析。门诊处方资料中疾病诊断采用ICD-10疾病分类标准进行分类,抗生素药品采用ATC药品分类法进行分类。粪便标本中ESBL菌株的检测主要由山东大学微生物实验室负责。研究结果 (1)42%的农村居民ESBL检测结果呈阳性,7岁以下儿童中ESBL阳性者占45%。被调查的18个村ESBL阳性率最低为22%,最高为64%。 (2)65%的农村居民表示知道或听过抗生素,但其中42%的人不能正确理解抗生素的用途。医生是农村居民获得抗生素知识的主要途径,居民的抗生素知识水平不是影响农村耐药流行的显著因素。 (3)80%的农村居民使用过抗生素,居民在选择抗生素时考虑的因素主要是医生的建议,其获得抗生素的场所主要是村卫生室。农村居民对抗生素的使用以及其规律服药行为、输液行为是影响耐药菌产生的相关因素。 (4)86%的农村医生了解抗生素使用的相关规定,并且大多数能够遵守。医生问卷中,仅1%的医生认为在患一般感冒时需使用抗生素,但实际处方行为中,56%的医生都给感冒患者开了抗生素。 (5)农村医疗机构平均抗生素处方率为39%,县乡村各级医疗机构分别为27%、29%和58%；平均抗生素联用处方率为18%,平均注射型抗生素的处方率为47%。大环内酯类和第三代头孢菌素类抗生素是农村地区使用最多的抗生素类型。结论与建议农村地区存在抗生素不合理使用情况,抗生素耐药流行程度严峻,尤其儿童的耐药情况不容乐观。影响农村地区抗生素耐药流行的因素主要是来自卫生服务供方,尤其是村卫生室医生。大多数农村医生的抗生素用药态度较为合理,但与实际处方行为并不一致,其处方中抗生素不合理应用程度严重。根据以上结论,提出下列建议： (1)建立农村地区抗生素使用和耐药监测评价体系是十分必要和紧迫的。农村居民的抗生素耐药形势已不容乐观,要加快相关研究工作的进展,加大对农村抗生素耐药研究工作的支持力度,尽快地建立起农村地区抗生素使用和耐药监测评价体系。 (2)开展农村居民抗生素使用相关健康教育活动,尤其是对儿童的家长进行健康教育。可以通过定期举办医生讲座来宣传抗生素合理用药知识,从而转变其不合理的用药观念和行为。 (3)加强对村医抗生素处方行为的监管,并要定期对村医进行合理用药知识的培训。村医的抗生素知识水平和处方行为如何直接关系到农村居民对抗生素的使用情况,要更加重视对村医合理用药知识的提高和处方行为的规制。
[Abstract]:Research background
Since the advent of penicillin in the 40s last century, the application of antibiotics has brought revolutionary changes to the treatment of bacterial infection. However, with the widespread use of antibiotics, the problem of its irrational use is becoming more and more serious. Some bacteria have gradually become resistant to antibiotics and aggravate the medical burden of the patients. Antibiotics in our country have been aggravated. The rate of drug resistance is increasing year by year. At present, the research on the mechanism of irrational use and resistance of antibiotics is to study the drug resistance of patients in medical institutions from the clinical point of view. Few studies have studied the cognition and behavior of health service providers and consumers and the use of antibiotics and antibiotics from the perspective of the population. The relationship between the production of antibiotic resistant bacteria. Rural areas is the heavy disaster area of antibiotic abuse in China, and there are few studies on the prevalence of antibiotic resistance in rural healthy population. Therefore, this study will provide the relevant monitoring system by evaluating the irrational use of antibiotics and the degree of bacterial resistance in rural residents in Shandong province. Scientific basis.
research objective
The purpose of this study was to assess the prevalence of antibiotic resistance in rural areas by measuring the prevalence of p- endemic amidase (ESBL) in rural areas, and to explore the related factors affecting the use of antibiotics and the prevalence of antibiotic resistance in rural areas by analyzing the awareness and behavior of rural residents and doctors in the use of antibiotics in order to promote agriculture. Reasonable suggestions for rational use of antibiotics and improving the health level of residents in villages are provided.
research method
According to the geographical location and economic development level, 3 counties (cities) were selected from Yanggu, Ningyang and Jiaonan in Shandong province. 3 towns were selected in each county, 2 villages were selected in each town. A questionnaire survey and collection of fecal specimens were carried out for 60 rural residents in each village. The outpatient prescriptions of medical institutions were carried out in each county, town and village. A total of 1014 questionnaires of rural residents, 1035 fecal specimens, and 1000 copies of the questionnaires and specimens were included in this study. A total of 188 questionnaires and 10676 outpatient prescriptions were collected.
Epidata3.1 is used to set up database for data entry, data is arranged and perfected in Excel2007, and SPSS17.0 is used to analyze and deduce the data by descriptive analysis and statistical inference. The statistical methods are mainly chi square test and two yuan Logistic regression analysis. The disease diagnosis of outpatient prescription data is classified by the classification of ICD-10 disease classification standard. ATC drugs were used to classify the raw drugs. The detection of ESBL strains in stool samples was mainly undertaken by the microbiology laboratory of Shandong University.
Research results
(1) 42% of rural residents were positive for ESBL test, while ESBL positive children under 7 years old accounted for 45%.. The lowest positive rate of ESBL in 18 villages surveyed was 22%, the highest being 64%.
(2) 65% of rural residents said they knew or heard antibiotics, but 42% of them did not understand the use of antibiotics correctly. Doctors were the main way for rural residents to acquire knowledge of antibiotics, and the level of antibiotic knowledge of the residents was not a significant factor affecting the prevalence of drug resistance in rural areas.
(3) 80% of rural residents used antibiotics, the main factors considered by residents in choosing antibiotics were doctors' suggestions, and the main sites for antibiotics were village health rooms. Rural residents' use of antibiotics and their regular medication behavior were related factors affecting the production of drug-resistant bacteria.
(4) 86% of rural doctors know the rules of antibiotic use, and most of them are able to comply. In the doctor's questionnaire, only 1% of doctors believe that antibiotics are needed when they are suffering from a common cold, but in the actual prescriptions, 56% of the doctors prescribe antibiotics to the cold.
(5) the average prescription rate of antibiotics in rural medical institutions is 39%, and the medical institutions at all levels in county and country are 27%, 29% and 58%, respectively. The average antibiotic combined prescription rate is 18%. The prescription rate of the average antibiotic is 47%. macrolide and third generation cephalosporins, which are the most used antibiotics in rural areas.
Conclusions and suggestions
There is an irrational use of antibiotics in rural areas, the prevalence of antibiotic resistance is severe, especially in children. The factors that affect the prevalence of antibiotic resistance in rural areas are mainly from the supply side of health services, especially in the village clinics. The actual prescribing behavior is not consistent. The irrational use of antibiotics in its prescriptions is serious.
In the light of the above conclusions, the following recommendations are made:
(1) it is necessary and urgent to establish the evaluation system of antibiotic use and resistance monitoring in rural areas. The situation of antibiotic resistance in rural residents is not optimistic. It is necessary to speed up the progress of relevant research work, increase the support for the study of antibiotic resistance in rural areas, and establish the monitoring of antibiotic use and drug resistance in rural areas as soon as possible. Evaluation system.
(2) to carry out health education activities related to the use of antibiotics in rural residents, especially for the parents of children. The knowledge of rational use of antibiotics can be propagandize through regular lectures of doctors to change their irrational drug use concepts and behaviors.
(3) to strengthen the supervision of the behavior of antibiotic prescriptions for village doctors, and to train regular knowledge of drug use for village doctors. The knowledge level and prescription behavior of the village doctors are directly related to the use of antibiotics in rural residents, and more attention should be paid to the improvement of the knowledge of rational drug use and the regulation of prescription behavior.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R978.1

【参考文献】