2019年中国多中心住院儿童抗菌药物应用分析  

A multi-center survey on the application of antibacterial agents in Chinese children in 2019

作　　者：张交生[1] 马香 唐兰芳[3] 田代印[4] 林立 李延琪[6] 钱婧[7] 张文双[8] 李威[9] 卢根 司利钢[11] 金萍 朱亮[13] 吴柯叶 邓继岿[1] 郑跃杰[15] 杨永弘[15,16] Zhang Jiaosheng;Ma Xiang;Tang Lanfang;Tian Daiyin;Lin Li;Li Yanqi;Qian Jing;Zhang Wenshuang;Li Wei;Lu Gen;Si Ligang;Jin Ping;Zhu Liang;Wu Keye;Deng Jikui;Zheng Yuejie;Yang Yonghong(Department of Infectious Diseases,Shenzhen Children′s Hospital,Shenzhen 518038,China;Department of Respiratory,Qilu Children′s Hospital of Shandong University,Jinan 250022,China;Department of Respiratory,the Children′s Hospital,Zhejiang University School of Medicine,Hangzhou 310005,China;Department of Respiratory,Children′s Hospital of Chongqing Medical University,Chongqing 400015,China;Department of Respiratory,The Second Affiliated Hospital&Yuying Children′s Hospital of Wenzhou Medical University,Wenzhou 325088,China;Department of Respiratory,Xi′an Children′s Hospital,Xi′an 710002,China;Department of Respiratory,Children′s Hospital,Capital Institute of Pediatrics,Beijing 100020,China;Department of Respiratory,Tianjin Children′s Hospital,Tianjin 300134,China;Department of Respiratory,the First Hospital of Jilin University,Changchun 130061,China;Department of Respiratory,Guangzhou Women and Children′s Medical Center,Guangzhou 510620,China;Department of Pediatrics,the First Hospital of Harbin Medical University,Harbin 150007,China;Pediatric Intensive Care Unit,Shenzhen Bao′an Maternity&Child Health Hospital,Shenzhen 518133,China;Department of Infectious diseases,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Cardiothoracic Surgery,Shenzhen Children′s Hospital,Shenzhen 518038,China;Department of Respiratory,Shenzhen Children′s Hospital,Shenzhen 518038,China;Beijing Pediatric Research Institute,Laboratory of Microbiology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]深圳市儿童医院感染科,深圳518038 [2]山东大学齐鲁儿童医院呼吸科,济南250022 [3]浙江大学医学院附属儿童医院呼吸科,杭州310005 [4]重庆医科大学附属儿童医院呼吸科,重庆400015 [5]温州医科大学附属第二医院、育英儿童医院呼吸科,温州325088 [6]西安市儿童医院呼吸科,西安710002 [7]首都儿科研究所附属儿童医院呼吸科,北京100020 [8]天津市儿童医院呼吸科,天津300134 [9]吉林大学第一医院呼吸科,长春130061 [10]广州市妇女儿童医疗中心呼吸科,广州510620 [11]哈尔滨医科大学第一医院儿科,哈尔滨150007 [12]深圳市宝安妇幼保健院儿童重症医学科,深圳518133 [13]国家儿童医学中心,首都医科大学附属北京儿童医院感染科,北京100045 [14]深圳市儿童医院心胸外科,深圳518038 [15]深圳市儿童医院呼吸科,深圳518038 [16]国家儿童医学中心,首都医科大学附属北京儿童医院,北京市儿科研究所微生物研究室,北京100045

出　　处：《中华实用儿科临床杂志》2022年第14期1074-1081,共8页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家卫生健康委抗菌药物临床应用与耐药评价专家委员会研究项目(KJYWZWH-OT-02-2021-01);深圳市卫生系统临床研究项目(SZLY2018016);广东省高水平临床重点专科(深圳市配套建设经费)(SZGSP012)。

摘　　要：目的采用世界卫生组织(WHO)AWaRe分类[可广泛使用类(Access)、谨慎使用类(Watch)、保留类(Reserve)、未推荐类(Not-recommended)]方法及经典的解剖学/治疗学/化学分类系统(ATC)分析2019年中国多中心儿童及新生儿抗菌药物应用监测网调查的中国儿童抗菌药物种类分布情况。方法本研究采用横断面调查方法,在2019年9月至12月进行一次儿童抗菌药物应用的多中心横断面调查,在调查期限内选一天作为调查日,将所有住院患儿中使用抗菌药物者的信息通过基于网络的数据收集系统进行填报(https://garpec-31.mobilemd.cn/login.aspx?relogin=true)。共覆盖10个省市的13家医院。调查科室包括感染科、呼吸科、普外科、儿科重症监护病房、新生儿重症监护病房、新生儿科。根据AWaRe及ATC抗菌药物分类目录对临床应用的抗菌药物进行归类,描述儿童及新生儿抗菌药物应用种类的AWaRe及ATC分布。结果共来自13家中心的2644张抗菌药物处方纳入研究,用于儿童的抗菌药物处方数2134张(80.71%),新生儿抗菌药物处方数为510张(19.29%)。总的抗菌药物处方中,可广泛使用类368张(13.92%),谨慎使用类1973张(74.62%),保留使用类60张(2.27%)和未推荐类243张(9.19%)。排名前五的抗菌药物种类为第三代头孢菌素类1056个(39.94%)、大环内酯类492个(18.61%)、碳青霉烯类275个(10.40%)、青霉素含酶抑制剂类246个(9.30%)和第二代头孢菌素类136个(5.14%)。各中心的抗菌药物所占比例:可广泛使用类为0~30.00%,谨慎使用类为36.67%~97.20%,保留使用类为0~17.02%,未推荐类0~33.33%。用于儿童及新生儿肺炎的1360张处方中,其中可广泛使用类152张(11.18%),谨慎使用类1051张(77.28%),保留使用类37张(2.72%),未推荐类120张(8.82%)。用于儿童肺炎的抗菌药物种类为第三代头孢菌素类522个(38.38%)、大环内酯类388个(28.53%)、青霉素含酶抑制剂141个(10.37%)、碳青霉烯类117个(8.6%)和Objective To analyze the patterns of antibacterial agents in Chinese children surveyed by the China multi-center monitoring network for the application of antibacterial agents in children and neonates in 2019 by using World Health Organization(WHO)Access,Watch,Reserve and Not-recommended(AWaRe)and typical anatomical/therapeutic/chemical(ATC)in this study.Methods The cross-sectional method was adopted.A multi-center cross-sectional survey was conducted on one day from September to December 2019.The information of all inpatients taking antibiotics was uploaded to the network-based data collection system(https://garpec-31.mobilemd.cn/login.aspx?relogin=true).This study covered 13 hospitals from 10 provinces and cities in China.All hospitalized children in the Respiratory Department,Infectious Disease Department,General Surgery Department,Pediatric Intensive Care Units,Neonatal Intensive Care Units and Neonatology joined in this survey.The clinically used antibacterial agents were classified by AWaRe and ATC,and the AWaRe and ATC distributions of antibacterial agents prescribed for Chinese children and neonates were described.Results Of the 2644 antibiotic prescriptions included from 13 hospitals,2134(80.71%)were for children and 510(19.29%)were for neonates.Of all antibiotic prescriptions,there were 368(13.92%)Access antibiotics prescriptions,1973(74.62%)Watch prescriptions,60(2.27%)Reserve prescriptions and 243(9.19%)Not-recommended prescriptions.The top-five antibiotics prescribed for children and neonates were third-generation cephalosporins(1056,39.94%),macrolides(492,18.61%),carbapenems(275,10.40%),beta lactam-beta lactamase inhibitors(246,9.30%),and second-generation cephalosporins(136,5.14%).The use ratios of Access,Watch,Reserve and Not-recommended antibiotics in each center ranged from 0 to 30.00%,36.67%to 97.20%,0 to 17.02%and 0 to 33.33%,respectively.In 1360 antibiotic prescriptions for children and neonates with pneumonia,there were 152(11.18%)Access antibiotics,1051(77.28%)Watch antibiotics,37(2.72%)Res

关 键 词：抗菌药物 儿童 婴儿 新生 处方 

分 类 号：R969.3[医药卫生—药理学]