儿童重症监护病房病原菌检测和抗菌药物使用调查分析

目的：分析重症监护病房（PICU）患儿病原菌分布和抗菌药物应用情况，为促进合理用药提供依据。方法：回顾性调查2014年10月至2016年10月无锡市儿童医院PICU使用抗菌药物患儿住院病历，分析病原菌检测结果、主要诊断和抗菌药物应用状况。结果：226例使用抗菌药物的患儿共送检362份标本，检出68株细菌和真菌，阳性率18.78%。按检出率排序前3位为大肠埃希菌（27.94%）、金黄色葡萄球菌（22.06%）和肺炎克雷伯菌（13.24%）。有感染诊断的199例患儿中呼吸道感染占73.37%。226例患儿共使用263例次抗菌药物，其中联合用药36例，占15.93%，使用第三代头孢菌素（含酶抑制剂的复方制剂）及氧头孢烯类抗菌药物187例，占71.10%。不合理医嘱排名前3位分别为遴选药品不适宜31条（41.89%），适应证不适宜15条（20.27%），用法用量不适宜14条（18.92%）。抗菌药物费用占总药品费用34.03%。结论：无锡市儿童医院PICU病原学送检率较高，但部分患儿存在适应症不适宜、用法用量不适宜、更换药品不合理等现象，需要加强抗菌药物合理使用的管理。

Survey on Pathogen and Antimicrobial of Using Antibiotic Patients in Pediatric Intensive Care Unit

Objective: To investigate the pathogens and overall antibiotic of using antibiotic patients in pediatric intensive care unit (PICU) in order to provide the evidence for rational use of antibiotic. Methods: All the patients discharged from PICU during the period from October 2014 to October 2016 were retrospectively reviewed for their clinical data including the pathogen, the diagnosis and the antibiotic use. Results: Total of 226 patients were included in this analysis. 68 strains of bacteria and fungi were detected from 362 samples, arranged as E. coli (27.94%), Staphylococcus aureus (22.05%) and Klebsiella pneumoniae (13.23%). 199 cases of infection disease diagnosis with lower respiratory tract infection accounted for 55.79%. These patients used a total of 273 kinds of antimicrobial agents. 15.93% of the patients received combination antimicrobial therapy. The third generation of cephalosporins including enzyme inhibitors and oxygen cephalosporins up to 187 species accounting for 68.49%. The cost of antimicrobial drugs accounted for 34.03% of all drug costs. Conclusion: The main problems in PICU antibacterials'' application were some unreasonable application phenomenons. It is necessary to enhance antibiotic stewardship.