基層醫療機構兒童CAP抗生素合理使用情況調查

于桂花 趙文利 楊寧 谷建波 周婷

[摘要] 目的 調查基層醫療機構兒童社區獲得性肺炎（CAP）抗生素使用遵循相關指南情況，優化基層合理用藥。方法 檢索2016年1月至2020年12月北京市昌平區醫院兒科出院病歷，收集納入病例抗生素使用情況（用藥選擇、用藥方式、用藥途徑、用藥療程及用藥頻次），進行統計學處理。 結果 ①納入CAP病例共3338例，男1863例，女1475例;年齡29 d～14歲，中位數3歲，平均（3.50±2.78）歲;住院天數4～21 d，中位數8 d，平均（8.05±2.64）d。②抗生素選擇：共涉及4類11種抗生素。大環內酯類最多，達2484例，占納入病例的74.41%。其次為β內酰胺類，其中3代頭孢菌素共1271例，占納入病例的38.08%;1代頭孢菌素23例，占6.89%;2代頭孢菌素19例，占5.70%;頭霉素衍生物頭孢米諾251例，占7.51%。③用藥方式：單藥治療2487例，占74.5%;聯合用藥851例，占25.5%，以大環內酯類聯合頭孢菌素最多。④用藥途徑：靜脈注射給藥共3312例（99.22%）;單藥口服治療共26例（0.78%）。⑤用藥療程：4～17 d，中位數6 d，平均（6.49±2.21）d。⑥各年度用藥頻次：以2019年最多，共7281 d;其次為2017年，共6544 d;2020年最少，僅1425 d。 結論 阿奇霉素在我院治療兒童CAP抗生素使用中處于絕對優勢，其次為3代頭孢菌素，單藥治療為主，靜脈給藥為主。我院對患兒CAP的抗生素使用基本遵循國內外相關指南推薦意見，但仍有不足之處，尚需對醫護人員和公眾加強不當使用抗生素的危險性教育，促進抗生素合理使用。

[關鍵詞] 兒童;社區獲得性肺炎（CAP）;抗生素;基層醫療機構

[中圖分類號] R969.3? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）24-0001-05

Investigation on the rational use of antibiotics in children with CAP in primary medical institutions

YU Guihua1? ?ZHAO Wenli2? ?YANG Ning1? ?GU Jianbo3? ?ZHOU Ting1

1.Department of Pediatrics， Changping District Teaching Hospital， Capital Medical University， Beijing? ?102200， China;

2.Department of Pediatrics， the PLA Rocket Force Characteristic Medical Center， Beijing? ?100032， China; 3.Department of Information， Changping District Teaching Hospital， Capital Medical University， Beijing? ?102200， China

[Abstract] Objective To investigate the use of antibiotics for community-acquired pneumonia （CAP） in children in primary medical institutions following relevant guidelines and optimize the rational use of drugs at the primary level. Methods The discharge medical records of the Pediatrics Department of Beijing Changping District Hospital from January 2016 to December 2020 were retrieved. The antibiotic use status of the included cases （drug selection， mode of medication administration， medication route， medication course， and medication frequency） was collected and statistically processed. Results ①A total of 3338 CAP cases were included， including 1863 males and 1475 females; the age ranged from 29 days to 14 years， with a median of 3 years and an average of （3.50±2.78） years; the length of hospital stay ranged from 4 days to 21 days， with a median of 8 days and an average of （8.05±2.64） days. ②Antibiotic selection： A total of 11 antibiotics in 4 categories were involved. Macrolides were the most common， reaching 2484 cases， accounting for 74.41% of the included cases. This was followed by β-lactams， including 1271 third-generation cephalosporins， accounting for 38.08%; 23 first-generation cephalosporins， accounting for 6.89%; 19 second-generation cephalosporins， accounting for 5.70%; and 251 cephamycin-derivative cefminox， accounting for 7.51%. ③Mode of medication administration： 2487 cases （74.5%） were treated with a single drug， accounting for 74.5%; 851 cases were treated with combined drugs， accounting for 25.5%， with the combination of macrolides and cephalosporins as the most common. ④Route of medication： 3312 cases （99.22%） were administered intravenously; 26 cases （0.78%） were treated with single-drug orally. ⑤Medication course： 4-7 d， median 6 d， average （6.49±2.21） d. ⑥The frequency of medication use in each year： the most in 2019， a total of 7281 days; followed by 2017， a total of 6544 days; and the least in 2020， only 1425 days. Conclusion Azithromycin has an absolute advantage in the antibiotics use for the treatment of CAP in children in our hospital， followed by the third-generation cephalosporin， which is mainly monotherapy and intravenous administration. The use of antibiotics for children with CAP in our hospital basically follows the recommendations of relevant domestic and foreign guidelines. However， there are still shortcomings. It is still necessary to strengthen education on the dangers of improper use of antibiotics for medical staff and the public to promote the rational use of antibiotics.