本文選題：抗生素耐藥性 + 農(nóng)村居民　； 參考：《山東大學(xué)》2014年碩士論文

【摘要】：研究背景 自上個世紀(jì)40年代青霉素問世以來,抗生素的應(yīng)用給細(xì)菌感染的治療帶來了革命性的改變,但隨著抗生素的廣泛應(yīng)用,其不合理使用的問題也越來越嚴(yán)重,部分細(xì)菌逐漸對抗生素類藥物產(chǎn)生耐藥性,加重了患者的醫(yī)療負(fù)擔(dān)。我國的抗生素耐藥率正在逐年升高,而目前國內(nèi)關(guān)于抗生素不合理使用和耐藥機(jī)制的研究,更多的是從臨床的角度出發(fā),研究醫(yī)療機(jī)構(gòu)患者的細(xì)菌耐藥情況,很少有研究從人群的角度出發(fā),研究衛(wèi)生服務(wù)提供者和消費者的認(rèn)知和行為與抗生素使用和耐藥菌產(chǎn)生之間的關(guān)系。農(nóng)村地區(qū)是我國抗生素濫用的重災(zāi)區(qū),而關(guān)于農(nóng)村健康人群中抗生素耐藥流行程度的研究幾乎沒有。因此,本研究將通過評估山東省農(nóng)村居民抗生素不合理使用和細(xì)菌耐藥的程度來為相關(guān)監(jiān)測體系的建立提供科學(xué)依據(jù)。 研究目的 本研究的目的是通過檢測農(nóng)村居民攜帶超廣譜p-內(nèi)酰胺酶(ESBL)的情況來評估農(nóng)村地區(qū)抗生素耐藥的流行程度,并通過分析農(nóng)村居民和醫(yī)生對抗生素使用的認(rèn)知和行為來探索影響農(nóng)村地區(qū)抗生素使用和耐藥流行的相關(guān)因素,為促進(jìn)農(nóng)村地區(qū)抗生素合理使用,提高居民健康水平提供合理建議。 研究方法 根據(jù)地理位置和經(jīng)濟(jì)發(fā)展水平在山東省抽取了陽谷、寧陽和膠南3個縣(市),每個縣選取3個鎮(zhèn),每鎮(zhèn)選取2個村進(jìn)行調(diào)查。在每個村對60名農(nóng)村居民進(jìn)行了問卷調(diào)查和糞便標(biāo)本的收集,在每個被調(diào)查的縣、鎮(zhèn)、村均進(jìn)行了醫(yī)療機(jī)構(gòu)門診處方資料的收集和醫(yī)生問卷的調(diào)查。收集1014份農(nóng)村居民問卷,1035份糞便標(biāo)本,問卷與標(biāo)本相匹配者共1000份將被納入本研究的分析。共收集了188份醫(yī)生問卷,10676份張門診處方。 采用Epidata3.1建立數(shù)據(jù)庫進(jìn)行數(shù)據(jù)錄入,在Excel2007中對數(shù)據(jù)進(jìn)行整理和完善,使用SPSS17.0對數(shù)據(jù)進(jìn)行描述性分析和統(tǒng)計推斷,統(tǒng)計方法主要是卡方檢驗和二元Logistic回歸分析。門診處方資料中疾病診斷采用ICD-10疾病分類標(biāo)準(zhǔn)進(jìn)行分類,抗生素藥品采用ATC藥品分類法進(jìn)行分類。糞便標(biāo)本中ESBL菌株的檢測主要由山東大學(xué)微生物實驗室負(fù)責(zé)。 研究結(jié)果 (1)42%的農(nóng)村居民ESBL檢測結(jié)果呈陽性,7歲以下兒童中ESBL陽性者占45%。被調(diào)查的18個村ESBL陽性率最低為22%,最高為64%。 (2)65%的農(nóng)村居民表示知道或聽過抗生素,但其中42%的人不能正確理解抗生素的用途。醫(yī)生是農(nóng)村居民獲得抗生素知識的主要途徑,居民的抗生素知識水平不是影響農(nóng)村耐藥流行的顯著因素。 (3)80%的農(nóng)村居民使用過抗生素,居民在選擇抗生素時考慮的因素主要是醫(yī)生的建議,其獲得抗生素的場所主要是村衛(wèi)生室。農(nóng)村居民對抗生素的使用以及其規(guī)律服藥行為、輸液行為是影響耐藥菌產(chǎn)生的相關(guān)因素。 (4)86%的農(nóng)村醫(yī)生了解抗生素使用的相關(guān)規(guī)定,并且大多數(shù)能夠遵守。醫(yī)生問卷中,僅1%的醫(yī)生認(rèn)為在患一般感冒時需使用抗生素,但實際處方行為中,56%的醫(yī)生都給感冒患者開了抗生素。 (5)農(nóng)村醫(yī)療機(jī)構(gòu)平均抗生素處方率為39%,縣鄉(xiāng)村各級醫(yī)療機(jī)構(gòu)分別為27%、29%和58%；平均抗生素聯(lián)用處方率為18%,平均注射型抗生素的處方率為47%。大環(huán)內(nèi)酯類和第三代頭孢菌素類抗生素是農(nóng)村地區(qū)使用最多的抗生素類型。 結(jié)論與建議 農(nóng)村地區(qū)存在抗生素不合理使用情況,抗生素耐藥流行程度嚴(yán)峻,尤其兒童的耐藥情況不容樂觀。影響農(nóng)村地區(qū)抗生素耐藥流行的因素主要是來自衛(wèi)生服務(wù)供方,尤其是村衛(wèi)生室醫(yī)生。大多數(shù)農(nóng)村醫(yī)生的抗生素用藥態(tài)度較為合理,但與實際處方行為并不一致,其處方中抗生素不合理應(yīng)用程度嚴(yán)重。 根據(jù)以上結(jié)論,提出下列建議： (1)建立農(nóng)村地區(qū)抗生素使用和耐藥監(jiān)測評價體系是十分必要和緊迫的。農(nóng)村居民的抗生素耐藥形勢已不容樂觀,要加快相關(guān)研究工作的進(jìn)展,加大對農(nóng)村抗生素耐藥研究工作的支持力度,盡快地建立起農(nóng)村地區(qū)抗生素使用和耐藥監(jiān)測評價體系。 (2)開展農(nóng)村居民抗生素使用相關(guān)健康教育活動,尤其是對兒童的家長進(jìn)行健康教育�？梢酝ㄟ^定期舉辦醫(yī)生講座來宣傳抗生素合理用藥知識,從而轉(zhuǎn)變其不合理的用藥觀念和行為。 (3)加強(qiáng)對村醫(yī)抗生素處方行為的監(jiān)管,并要定期對村醫(yī)進(jìn)行合理用藥知識的培訓(xùn)。村醫(yī)的抗生素知識水平和處方行為如何直接關(guān)系到農(nóng)村居民對抗生素的使用情況,要更加重視對村醫(yī)合理用藥知識的提高和處方行為的規(guī)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.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R978.1

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