本文選題：新生兒　切入點：血源性感染　出處：《重慶醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的：探討抗菌藥物臨床應用控制對新生兒血源性感染病原學及臨床特點的影響，發(fā)現抗菌藥物控制執(zhí)行過程中的問題及其帶來的利弊，為制定進一步的抗菌藥物用藥規(guī)范提供依據。 方法：以2010年（控制前組）和2013年（控制后組）我院新生兒病房所有患者為總體研究對象。出院診斷為確診或疑診新生兒敗血癥、化膿性腦膜炎、急性血源性骨髓炎（以下統稱 血源性感染‖）的病例分別有542例和1239例，按照《實用新生兒學》第四版、《小兒外科學》第四版（人民衛(wèi)生出版社）中的診斷標準進行重新評估，將確診病例納入研究，分別有168例和470例，對其臨床資料進行回顧性研究。 結果：1.2010年、2013年新生兒病房所有病例總體情況：①2013年病房共收治患者7265例，2010年共收治患者6045例，血源性感染收治率2013年（6.47%）較2010年（2.78%）升高（P0.01）。②血源性院內感染發(fā)生率2013年(0.70%)較2010年(0.30%)升高（P=0.001）。③抗菌藥物使用率2013年（79.25%）較2010年（91.83%）顯著降低（P＜0.01）；抗菌藥物使用強度2013年（8.37）較2010年（10.65）降低。2.2010年、2013年血源性感染病例情況：①革蘭陽性菌感染率2013年（52.08%）較2010年（75.32%）降低（P=0.001）；革蘭陰性菌、真菌感染率2013年（40.97%、6.94%）均較2010年（24.68%、0.00%）升高（P=0.016，P=0.018）。②兩組血培養(yǎng)檢出率前四位病原菌均為溶血葡萄球菌、表皮葡萄球菌、肺炎克雷伯菌肺炎亞種、大腸埃希氏菌，四種細菌的MRS、β-內酰胺酶陽性、ESBL陽性等耐藥情況無統計學差異（P0.05）。③青霉素類、頭孢菌素類第一二代、三四代使用率2013年（73.62%、21.28%、39.79%）較2010年（92.86%、75%、53.57%）顯著降低（P＜0.01）；碳青霉烯類使用率2013年（35.74%）較2010年（16.07%）升高（P＜0.01）；兩組糖肽類使用率比較無統計學差異（P=0.261）。④2013年抗菌藥物聯用以單用為主（59.87%），2010年以二聯為主（85.71%），，兩組比較有統計學差異（P0.01）。⑤抗菌藥物更換次數2013年（0.83±1.037）較2010年（1.07±1.135）減少（P=0.013）。⑥抗菌藥物使用天數2013年（15.45±13.36）較2010年（12.12±10.7）增加（P=0.001）。⑦兩組出院轉歸比較無統計學差異（P0.05）。⑧平均住院天數2013年（16.08±14.345）較2010年（11.96±12.356）增加（P0.01）。 結論：我院新生兒病房自2012年8月起正式實施抗菌藥物臨床應用控制方案，2013年抗菌藥物的使用率、使用強度均較2010年下降；對于血源性感染，最常見病原菌及其耐藥情況無顯著變化，抗菌藥物的更換次數、聯用情況有顯著改善，血源性院內感染發(fā)生率升高，但未增加患兒病情恢復不良的風險。
[Abstract]:Objective: to explore the effect of clinical application control of antimicrobial agents on the etiology and clinical characteristics of neonatal hematogenous infection, and to find out the problems and advantages and disadvantages in the process of carrying out the control of antimicrobial agents. To provide a basis for the formulation of further antimicrobial drug use norms. Methods: all the patients in the neonatal wards of our hospital on 2010 (before control) and 2013 (after control) were selected as the general subjects. The patients were diagnosed as septicemia or suppurative meningitis. There were 542 cases of acute hematogenous osteomyelitis (hereinafter referred to as hematogenous infection) and 1239 cases of acute hematogenous osteomyelitis, According to the diagnostic criteria in 4th edition of practical Neonatology and 4th Edition of Pediatric surgery (people's Health Publishing House), the confirmed cases were included in the study, 168 cases and 470 cases, respectively. The clinical data were retrospectively studied. Results: 1. In 2010, in 2013, all the cases in neonatal ward were as follows: 1 in 2013, 7265 cases were admitted in ward, and 6045 cases were admitted in 2010. The incidence of hematogenous nosocomial infection in 2013 (6.47) was significantly higher than that in 2010 (2.78)) the incidence of hematogenous nosocomial infection was increased in 2013 (0.70) and in 2013 (0.30).) the utilization rate of antimicrobial agents in #datea- 79.25.3) was significantly lower than that in #datem91.83C (P < 0.01); the intensity of antimicrobial use in #date6 # / 8.37) was significantly lower than that in 2013 (8.37). In 2013, the infection rate of Gram-positive bacteria (52.08) was lower than that of 2010 (75.32). (2.The infection rate of Gram-positive bacteria in 2013 was lower than that in 2010 (75.32), and the rate of Gram-negative bacteria was lower than that of 2010 (P < 0.05). The infection rate of fungi in 2013 was higher than that in 2010 (24.68).) the first four pathogens were Staphylococcus haemolyticus, Staphylococcus epidermidis, Klebsiella pneumoniae pneumonia subspecies, Escherichia coli in the two groups, and the first four pathogens were Staphylococcus haemolyticus, Staphylococcus epidermidis, Klebsiella pneumoniae pneumonia subspecies, Escherichia coli. There was no significant difference in resistance to MRS, 尾 -lactamase positive ESBL among the four bacteria (P0.053.penicillin, cephalosporins for 12th generations). The utilization rate of the third and fourth generations in 2013 was significantly lower than that in 2010 (92.86775 and 53.57); the utilization rate of carbapenems was 35.74g (2013) higher than that of 2013 (16.07); there was no statistical difference between the two groups in the utilization rate of glycopeptide (P 0.261 1). 4in 2013, the combination of antimicrobial agents was mainly used alone (59.87%), and the usage rate of carbapenem was higher than that of 2013 (16.07 7); there was no statistical difference between the two groups in the utilization rate of glycopeptide (P < 0.01). There was a significant difference between the two groups in the number of antimicrobial drug changes (0.83 鹵1.037 on 2013) and 1.07 鹵1.135 on 2010 (P < 0.013.6). The number of days used with antimicrobial agents decreased in 2013 (15.45 鹵13.36) than in 2013 (12.12 鹵10.7). There was no statistical difference between the two groups in the outcome of discharge. There was no statistical difference between the two groups in the average hospitalization days (P 0.05.8). The number on 2013 was 16.08 鹵14.345), which was higher than that on 2010 (11.96 鹵12.356). Conclusion: the clinical application control scheme of antimicrobial agents has been implemented since August 2012 in neonatal wards of our hospital. The utilization rate and intensity of antibiotics in 2013 were lower than those in 2010. There was no significant change in the most common pathogens and their drug resistance. The frequency of change of antibiotics and the combined use of antibiotics were significantly improved. The incidence of hematogenous nosocomial infection was increased, but the risk of poor recovery was not increased.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R722.1

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