脓毒症抗菌药物降阶梯治疗的应用现状及其对结局的影响  

Current application of antibiotic de-escalation treatment in children with sepsis and its impact on prognosis

作　　者：赵艳 杨妮[1] 刘春峰[1] Zhao Yan;Yang Ni;Liu Chunfeng(Department of Pediatrics,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院儿科,沈阳110004

出　　处：《中华儿科杂志》2022年第3期203-208,共6页Chinese Journal of Pediatrics

基　　金：国家自然基金(81971810);辽宁省重大科技专项(2020JH1/10300001);沈阳市科技攻关项目(20-205-4-002)。

摘　　要：目的分析儿童重症监护病房(PICU)细菌培养阳性的脓毒症患儿经验性抗菌药物治疗的恰当性,探讨抗菌药物降阶梯(ADE)治疗在PICU脓毒症患儿中的应用情况及其对结局的影响。方法回顾性分析2018年1月至2020年12月中国医科大学附属盛京医院PICU收治的123例脓毒症相关器官功能障碍及脓毒性休克患儿的一般情况、实验室检查、经验性抗菌药物使用及调整情况和ADE的实施率等临床资料。根据抗菌药物调整情况分为降阶梯组和非降阶梯组,比较其临床特点和结局指标。组间比较采用独立样本t检验、Mann-Whitney U检验、χ^(2)检验或Fisher确切概率法。结果123例患儿中男70例、女53例,年龄11.4(2.8,56.5)月龄,其中41例体液培养阳性,经验性抗菌药物治疗不足的有3例(7.3%),使用充足的有38例(92.7%),其中28例为抗菌药物使用过度,10例抗菌药物使用恰当。降阶梯组患儿46例、非降阶梯组患儿77例,两组间PICU全因病死率、住院花费、住院期间的机械通气时间及再次感染发生率差异均无统计学意义(均P>0.05)。对使用过针对多重耐药菌抗菌药物的101例患儿而言,降阶梯组患儿43例、非降阶梯组患儿58例,降阶梯组此类抗菌药物的使用时间比非降阶梯组短[5.0(4.0,12.0)比9.5(7.0,13.0)d,Z=-3.14,P=0.002]。结论经验性抗菌药物使用过度情况仍非常常见,但ADE的应用情况却不理想,ADE可以减少针对多重耐药菌抗菌药物的使用时间,并且对脓毒症患儿的结局无明显不良影响。Objective To analyze the eligibility of empirical antibiotic therapy in culture positive sepsis in the pediatric intensive care unit(PICU),and to explore the application of antibiotic de-escalation(ADE)in children with sepsis and its impact on prognosis.Methods A total of 123 children with sepsis-associated organ dysfunction or septic shock admitted to the PICU of Shengjing Hospital of China Medical University from January 2018 to December 2020 were retrospectively analyzed.The general information,laboratory tests,the use of empirical anti-bacterial drugs and the application of ADE were collected.According to the adjustment of anti-bacterial drugs,these children were divided into ADE group and non-ADE group.Comparisons between groups were performed with unpaired Student t test,or Mann-Whitney U test,or chi-square test or Fisher exact test.Results In these 123 children,70 were males and 53 were females,the age was 11.4(2.8,56.5)months.Body fluid culture was detected positive in 41 children including 3 children(7.3%)who received inadequate empirical antibiotic therapy and 38 children(92.7%)who received adequate empirical antibiotic therapy.Excluding 10 children who received appropriate therapy,28 received unnecessary broad-spectrum antibiotics.There were no significant differences regarding the PICU all-cause mortality rates,length of PICU stay,hospitalization cost,duration of mechanical ventilation,as well as incidences of re-infection between the ADE group(n=46)and non-ADE group(n=77)(all P>0.05).However,among the 101 children who have used antibiotics against multidrug-resistant organism,the duration of such antibiotics use in ADE group(n=43)was shorter than that in non-ADE group(n=58)(5.0(4.0,12.0)vs.9.5(7.0,13.0)d,Z=-3.14,P=0.002).Conclusions Overuse of unnecessary broad-spectrum empirical antibiotics is very common,but the application of ADE is rather disappointing.ADE can reduce the use of anti-bacterial drugs against multi-drug resistant bacteria without significant adverse effects on prognosis in children

关 键 词：抗菌药 脓毒症 儿童 预后 

分 类 号：R720.597[医药卫生—急诊医学]