新生兒重癥監(jiān)護(hù)室控制抗菌藥物應(yīng)用前后抗生素應(yīng)用合理性調(diào)查
發(fā)布時間：2018-11-19 21:35
【摘要】：目的:探討控制抗菌藥物應(yīng)用對新生兒重癥監(jiān)護(hù)室抗生素應(yīng)用合理性的影響。方法:對我院新生兒一病區(qū)重癥監(jiān)護(hù)室(NICU)于2010年6月(控制前)與2015年6月(控制后)出院的患兒91例及101例的臨床資料進(jìn)行回顧性研究。對抗生素使用情況以改良CDC 12-Step標(biāo)準(zhǔn)進(jìn)行分析評估。對患兒的一般資料、臨床資料和抗生素使用情況進(jìn)行分析。不合理使用的抗生素療程按抗生素種類、使用天數(shù)、改良CDC 12-Step標(biāo)準(zhǔn)進(jìn)行分析。結(jié)果:(1)控制前抗生素療程中位數(shù)為14天(7-23天),控制后抗生素療程中位數(shù)為16.5天(6-24天),兩組比較差異無統(tǒng)計學(xué)意義(Z=0.251,P0.05)。(2)控制前有69(67%)個療程、406(22%)個抗生素使用日被認(rèn)為是不合理的。控制后組有56(49%)個療程、357(18%)個抗生素使用日被認(rèn)為是不合理的。兩組比較均有統(tǒng)計學(xué)差異(x~2值分別為5.711和15.018,P均0.05)。(3)控制前初期使用抗生素不合理療程比例為25%(26/103),持續(xù)使用抗生素不合理療程比例為47%(36/76);控制后療程初期抗生素不合理療程比例為25%(28/114),持續(xù)使用抗生素不合理療程比例為56%(55/99)。持續(xù)使用抗生素不合理比例均大于初期使用抗生素不合理比例(控制前后x~2值分別為9.456和21.402,P0.05)。(4)控制前、后“及時停用抗生素”不合理比例分別為48%和57%,兩組比較有統(tǒng)計學(xué)差異(x~2=6.274,P0.05);“知道對廣譜抗生素‘說不’”這一項目的不合理比例分別為27%和19%,兩組比較有統(tǒng)計學(xué)差異(x~2=6.005,P0.05)。(5)抗菌藥物控制前最常使用的抗生素是頭孢西丁(729天),其中138天(19%)是不合理的;抗菌藥物控制后最常使用的抗生素是青霉素(645天),其中109天(17%)是不合理的。結(jié)論:抗菌藥物控制后抗生素使用合理性有所改善。但在持續(xù)使用抗生素時不合理情況仍然嚴(yán)重�？咕幬锟刂魄啊⒑髮Α凹皶r停用抗生素”標(biāo)準(zhǔn)都執(zhí)行不好。在使用抗生素時,應(yīng)密切關(guān)注新生兒的臨床體征的變化,隨訪感染生化指標(biāo),有停藥指征后應(yīng)立即停用抗生素。同時,應(yīng)注意避免對第三代頭孢菌素的濫用。
[Abstract]:Objective: to investigate the effect of antimicrobial control on the rationality of antibiotic application in neonatal intensive care unit (NICU). Methods: the clinical data of 91 cases and 101 cases of neonatal intensive care unit (NICU) discharged from hospital in June 2010 (before control) and June 2015 (after control) were retrospectively studied. Use of antibiotics to improve the CDC 12-Step standard was analyzed and evaluated. The general data, clinical data and antibiotic use of children were analyzed. The course of irrational use of antibiotics was analyzed according to the types of antibiotics, the days of use and the modified CDC 12-Step criteria. Results: (1) the median course of antibiotic treatment was 14 days (7-23 days) before control and 16.5 days (6-24 days) after control. P0.05). (2) there were 69 (67%) courses of treatment before control, and 406 (22%) days of antibiotic use were considered unreasonable. After control, 56 (49%) courses and 357 (18%) days of antibiotic use were considered unreasonable. There was statistical difference between the two groups (x2 was 5.711 and 15.018). (3, respectively). The rate of irrational course of treatment before control was 25% (26 / 103). The rate of continuous use of antibiotics was 47% (36 / 76). The rate of irrational antibiotic treatment was 25% (28 / 114) at the initial stage of the controlled course and 56% (55 / 99) on the continuous use of antibiotics. The irrational proportion of continuous use of antibiotics was higher than that of initial use of antibiotics (x2 was 9.456 and 21.402). (4 respectively before and after control) before and after control. The unreasonable proportion of "stop antibiotics in time" was 48% and 57% respectively, there was statistical difference between the two groups (P 0.05). The irrational rates of "know to say no" to broad-spectrum antibiotics were 27% and 19%, respectively. There was a statistical difference between the two groups. P0.05). (5) the most commonly used antibiotics before antimicrobial control were cefoxitin (729 days), of which 138th days (19%) were unreasonable; Penicillin (645 days) is the most commonly used antibiotic after antimicrobial control, of which 109 days (17%) are unreasonable. Conclusion: the rational use of antibiotics has been improved after the control of antimicrobial agents. However, the irrational use of antibiotics is still serious. Antimicrobial control before, after the "stop antibiotics in time" standard are not implemented well. When using antibiotics, we should pay close attention to the changes of clinical signs of newborns, follow up the biochemical indicators of infection, and stop antibiotics immediately after the indication of withdrawal. At the same time, attention should be paid to avoid the abuse of the third generation cephalosporins.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R722.1
[Abstract]:Objective: to investigate the effect of antimicrobial control on the rationality of antibiotic application in neonatal intensive care unit (NICU). Methods: the clinical data of 91 cases and 101 cases of neonatal intensive care unit (NICU) discharged from hospital in June 2010 (before control) and June 2015 (after control) were retrospectively studied. Use of antibiotics to improve the CDC 12-Step standard was analyzed and evaluated. The general data, clinical data and antibiotic use of children were analyzed. The course of irrational use of antibiotics was analyzed according to the types of antibiotics, the days of use and the modified CDC 12-Step criteria. Results: (1) the median course of antibiotic treatment was 14 days (7-23 days) before control and 16.5 days (6-24 days) after control. P0.05). (2) there were 69 (67%) courses of treatment before control, and 406 (22%) days of antibiotic use were considered unreasonable. After control, 56 (49%) courses and 357 (18%) days of antibiotic use were considered unreasonable. There was statistical difference between the two groups (x2 was 5.711 and 15.018). (3, respectively). The rate of irrational course of treatment before control was 25% (26 / 103). The rate of continuous use of antibiotics was 47% (36 / 76). The rate of irrational antibiotic treatment was 25% (28 / 114) at the initial stage of the controlled course and 56% (55 / 99) on the continuous use of antibiotics. The irrational proportion of continuous use of antibiotics was higher than that of initial use of antibiotics (x2 was 9.456 and 21.402). (4 respectively before and after control) before and after control. The unreasonable proportion of "stop antibiotics in time" was 48% and 57% respectively, there was statistical difference between the two groups (P 0.05). The irrational rates of "know to say no" to broad-spectrum antibiotics were 27% and 19%, respectively. There was a statistical difference between the two groups. P0.05). (5) the most commonly used antibiotics before antimicrobial control were cefoxitin (729 days), of which 138th days (19%) were unreasonable; Penicillin (645 days) is the most commonly used antibiotic after antimicrobial control, of which 109 days (17%) are unreasonable. Conclusion: the rational use of antibiotics has been improved after the control of antimicrobial agents. However, the irrational use of antibiotics is still serious. Antimicrobial control before, after the "stop antibiotics in time" standard are not implemented well. When using antibiotics, we should pay close attention to the changes of clinical signs of newborns, follow up the biochemical indicators of infection, and stop antibiotics immediately after the indication of withdrawal. At the same time, attention should be paid to avoid the abuse of the third generation cephalosporins.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R722.1
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