基层医疗机构儿童CAP抗生素合理使用情况调查

于桂花 赵文利 杨宁 谷建波 周婷

[摘要] 目的 調查基层医疗机构儿童社区获得性肺炎（CAP）抗生素使用遵循相关指南情况，优化基层合理用药。方法 检索2016年1月至2020年12月北京市昌平区医院儿科出院病历，收集纳入病例抗生素使用情况（用药选择、用药方式、用药途径、用药疗程及用药频次），进行统计学处理。 结果 ①纳入CAP病例共3338例，男1863例，女1475例;年龄29 d～14岁，中位数3岁，平均（3.50±2.78）岁;住院天数4～21 d，中位数8 d，平均（8.05±2.64）d。②抗生素选择：共涉及4类11种抗生素。大环内酯类最多，达2484例，占纳入病例的74.41%。其次为β内酰胺类，其中3代头孢菌素共1271例，占纳入病例的38.08%;1代头孢菌素23例，占6.89%;2代头孢菌素19例，占5.70%;头霉素衍生物头孢米诺251例，占7.51%。③用药方式：单药治疗2487例，占74.5%;联合用药851例，占25.5%，以大环内酯类联合头孢菌素最多。④用药途径：静脉注射给药共3312例（99.22%）;单药口服治疗共26例（0.78%）。⑤用药疗程：4～17 d，中位数6 d，平均（6.49±2.21）d。⑥各年度用药频次：以2019年最多，共7281 d;其次为2017年，共6544 d;2020年最少，仅1425 d。 结论 阿奇霉素在我院治疗儿童CAP抗生素使用中处于绝对优势，其次为3代头孢菌素，单药治疗为主，静脉给药为主。我院对患儿CAP的抗生素使用基本遵循国内外相关指南推荐意见，但仍有不足之处，尚需对医护人员和公众加强不当使用抗生素的危险性教育，促进抗生素合理使用。

[关键词] 儿童;社区获得性肺炎（CAP）;抗生素;基层医疗机构

[中图分类号] R969.3          [文献标识码] B          [文章编号] 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.