405例发热患者院外抗菌药物应用分析  

Analysis of antibiotic use before visiting Peking Union Medical College Hospital in 405 febrile patients

作　　者：俞亚转 周宝桐[1] 刘正印[1] 李太生[1] YU Yazhuan;ZHOU Baotong;LIU Zhengyin;LI Taisheng(Department of Infectious Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院感染内科,北京100730 [2]海南医学院第二附属医院感染病与热带病科

出　　处：《中国感染与化疗杂志》2023年第6期695-701,共7页Chinese Journal of Infection and Chemotherapy

基　　金：中央高水平医院临床科研业务费(2022-PUMCH-B-043)。

摘　　要：目的探讨因发热住院患者就诊北京协和医院前的抗菌药物应用情况。方法收集2021年4月13日—2022年8月1日以发热为主要表现在北京协和医院感染内科住院患者的病历资料,分析患者的流行病学和临床资料,包括人口学、地区,患者体温峰值、病程、最终诊断、在北京协和医院之前的诊治情况如医疗机构信息、实验室检查、抗菌药物使用情况等。结果共纳入405例患者,男∶女=1.18(219/186),平均年龄50岁。患者来自全国各地,主要是北京市(131例,32.3%)、河北省(103例,25.4%)。大部分患者为中高热及以上(348例,85.9%)。近半数(198例,48.9%)曾就诊于三甲医院。外院经过病原学和影像学初步诊断为各种器官组织感染的有263例(64.9%),最常见的是呼吸系统感染,其次是消化系统感染。全部患者均接受了抗菌药物治疗,最常予2种抗菌药物(33.3%),极少数给予8~9种抗菌药物。抗菌药物使用共有502人次,女227人次(45.2%),男275人次(54.8%)。在北京协和医院诊治中,243例(60.0%)患者最终诊断为感染性疾病所致发热,细菌感染110例(27.2%),另162例(40.0%)患者属于非感染性发热。外院诊断的发热原因与北京协和医院最终诊断相符合的仅87例(21.5%)。感染与非感染性疾病患者的病程差异有统计学意义(P<0.05);但应用抗菌药物的疗程和种类差异均没有统计学意义(P>0.05)。应用频率最高的前三种抗菌药物是:头孢菌素类(246次,22.8%)、喹诺酮类(239次,22.1%)、青霉素类(113次,10.5%)。外院就诊过程中,有5例(1.2%)患者未查血常规,107例(26.4%)未查降钙素原,62例(15.3%)未查C反应蛋白,255例(63.0%)未行血培养,只有114例(28.1%)患者进行全部检查。结论发热患者无论病因诊断是否感染性疾病,应用抗菌药物的现象十分普遍,不合理应用抗菌药物的现象也比较常见。临床医师给发热患者予抗感染治疗前应充分评估,需结合患者临床表现及血�Objective To examine the use of antibacterial agents in patients with fever before visiting Peking Union Medical College Hospital(PUMCH).Methods The data of febrile patients who were treated from May 13,2021 to August 01,2022 in the Department of Infectious Diseases of PUMCH were reviewed and analyzed.The epidemiological and clinical data were analyzed,including peak temperature,duration of illness,final diagnosis,and treatment status(including the hospital information,laboratory tests,and use of antibacterial agents).Results A total of 405 patients were analyzed,including 219 males and 186 females(M/F ratio=1.18).The average age of patients was 50 years old.Those patients were mainly from Beijing(131/405,32.3%)and Hebei Province(103/405,25.4%).Most of them had moderate to high fever(348/405,85.9%).About half of the patients(48.9%,198/405)had visited a Grade A tertiary hospital.After initial laboratory and imaging evaluation,263(64.9%)patients were diagnosed with infectious diseases,mostly respiratory or digestive infections.All the patients received antibacterial treatment.Usually,two kinds of antibiotics were used(135/405,33.3%),even 8 or 9 different antibiotics were used in some patients.Overall,prior antibiotic consumption before visiting PUMCH was 502 person-time,227(45.2%)for women and 275(54.8%)for men.After admission to PUMCH,243 patients(60.0%)had a final diagnosis of fever due to infectious diseases and 110 of them were bacterial infections.The other 162 patients(40.0%)had a non-infectious fever.The prior diagnosis before visiting PUMCH was consistent with the diagnosis in PUMCH in only 87 cases(21.5%).The duration of illness was significantly different between patients with and without infectious diseases(P<0.05).However,the duration or types of antimicrobial therapies before visiting PUMCH did not show significant difference between patients with different types of illness(P>0.05).The top three antibacterial agents used before visiting PUMCH were cephalosporins(246 visits,22.8%),quinolones(239 visits,

关 键 词：发热 抗菌药物应用 C反应蛋白 降钙素原 血培养 

分 类 号：R978[医药卫生—药品]