某大型儿童医院门诊流感患者抗菌药物使用情况回顾性分析

蔡志波, 梁建凤, 林艳, 黄梦珊

中国药学杂志 ›› 2019, Vol. 54 ›› Issue (16) : 1336-1342.

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中国药学杂志
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中国药学杂志 ›› 2019, Vol. 54 ›› Issue (16) : 1336-1342. DOI: 10.11669/cpj.2019.16.012
论著

某大型儿童医院门诊流感患者抗菌药物使用情况回顾性分析

  • 蔡志波a, 梁建凤b, 林艳a, 黄梦珊a
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Antimicrobial Prescribing for Outpatients with Laboratory-confirmed Influenza in a Large Children′s Hospital: A Retrospective Study

  • CAI Zhi-boa, LIANG Jian-fengb, LIN Yana, HUANG Meng-shana
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摘要

目的 了解流感季节某大型儿童专科医院门诊流感患儿抗菌药物使用情况,为科学管理提供参考。方法 利用2017~2018年流感季节经实验室确诊的流感阳性病例(简称“流感患儿”)就诊信息,收集抗菌药物使用情况以及实验室辅助检查信息,通过临床诊断评价抗菌药物使用合理性;利用 Logistic 回归建立抗菌药物使用预测模型,用于检验相关因素对门诊流感患儿抗菌药物使用的影响。结果 在201例流感确诊患儿中有107例(53.2%)使用了抗菌药物(至少1种),其中92例(86.0%)使用不合理;绝大多数选用大环内酯类及第三代头孢菌素类抗菌药物,使用频次前3种抗菌药物为:阿奇霉素、头孢克肟和克拉霉素。根据预测模型,抗菌药物使用与患儿C-反应蛋白(CRP )浓度异常(校正OR=4.697;95%CI:2.187~10.090)以及快速流感诊断试验(RIDT)阴性结果( 校正OR=2.228;95%CI:1.058~4.692)显著相关,与患儿年龄、发病季节、抗流感病毒药使用、 白细胞计数、中性粒细胞比例、RIDT 阳性结果、临床诊断流感、流感分型不相关。结论 门诊流感患儿抗菌药物使用率高,管理部门应采取针对性措施,减少抗菌药物不合理使用。

Abstract

OBJECTIVE To investigate the usage of antimicrobial in outpatients with laboratory-confirmed influenza in a children′s hospital during the flu season, and to provide evidence for scientific antimicrobial stewardship. METHODS During the 2017-2018 flu season, medical records of laboratory-confirmed influenza positive cases in our hospital were reviewed to collect information including prescription of antimicrobial, laboratory data; and the rationality of the use of antimicrobial was evaluated based on clinical diagnosis. Logistic regression was used to establish the prediction model of antimicrobial usage, which was used to test the factors affecting usage of antimicrobial in outpatients with influenza infections. RESULTS Among 201 confirmed-influenza cases, 107 (53.2%) were prescribed antimicrobial (at least one drug), and 92 (86.0%) were treated irrationally. In most patients, macrolides and the third generation of cephalosporins were used; and the most frequently used antimicrobials were azithromycin, cefixime and clarithromycin. According to the prediction model, the use of antimicrobial was significantly associated with abnormal C-reactive protein (CRP) level in children (adjusted OR=4.697; 95%CI: 2.187-10.090) and negative results of rapid influenza diagnostic test (RIDT) (adjusted OR=2.228; 95%CI:1.058-4.692); age, onset season, use of anti-influenza virus drugs, white blood cell counting, proportion of neutrophils, RIDT positive results, a clinical diagnosis of influenza and influenza typing were not risk factors. CONCLUSION The rate of antimicrobial usage in out patients with in fluenza is high, and the management department should take targeted measures to reduce the unreasonable use of antimicrobial.

关键词

抗菌药物使用 / 流感 / 儿童 / 急性上呼吸道感染 / 合理用药

Key words

antimicrobial prescribing / influenza / children / acute upper respiratory tract infection / rational drug use

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蔡志波, 梁建凤, 林艳, 黄梦珊. 某大型儿童医院门诊流感患者抗菌药物使用情况回顾性分析[J]. 中国药学杂志, 2019, 54(16): 1336-1342 https://doi.org/10.11669/cpj.2019.16.012
CAI Zhi-bo, LIANG Jian-feng, LIN Yan, HUANG Meng-shan. Antimicrobial Prescribing for Outpatients with Laboratory-confirmed Influenza in a Large Children′s Hospital: A Retrospective Study[J]. Chinese Pharmaceutical Journal, 2019, 54(16): 1336-1342 https://doi.org/10.11669/cpj.2019.16.012
中图分类号： R969.3   

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