尘肺合并社区获得性肺炎患者病原菌分布及抗菌药物使用合理性评价

目的分析并对尘肺合并社区获得性肺炎(CAP)患者病原菌分布以及抗菌药物使用合理性进行评价。方法选取90例既往无其他慢性呼吸道疾病史的尘肺合并CAP患者作为研究组,另选同期90例既往无慢性呼吸道疾病史的CAP患者作为对照组。比较两组患者病原菌及耐药菌情况;白细胞、中性粒细胞百分比、C反应蛋白、白细胞介素-6、降钙素原升高情况;抗菌药物的使用情况。结果对照组培养出病原菌6株,4株杆菌,2株球菌(肺炎链球菌),无真菌,无耐药菌;研究组培养出病原菌18株,14株杆菌,1株球菌,3株真菌,其中耐药菌3株,占病原菌的16.67%。研究组病原菌占比20.0%高于对照组的6.67%,差异具有统计学意义(χ^2=6.923,P<0.05);两组病原菌中,耐药菌占比比较,差异无统计学意义(χ^2=1.143,P>0.05)。研究组C反应蛋白、白细胞介素-6升高率用药前后差值分别为54.44%、58.89%,均高于对照组的35.56%、36.67%,差异均具有统计学意义(P<0.05);两组白细胞、中性粒细胞百分比、降钙素原升高率用药前后差值比较,差异无统计学意义(P>0.05)。两组口服、静脉滴注、单用、联用抗菌药物情况比较,差异无统计学意义(P>0.05);研究组用药疗程>10 d占比52.22%高于对照组的27.78%,差异具有统计学意义(P<0.05)。研究组一、二代头孢菌素的总使用率32.22%低于对照组的50.00%,差异具有统计学意义(χ^2=5.875,P<0.05);研究组三代头孢菌素加酶抑制剂总使用率33.33%高于对照组的8.89%,差异具有统计学意义(χ^2=16.145,P<0.05)。结论尘肺合并CAP患者抗菌药物品种选择、疗程基本合理,但仍需加强抗菌药物培训管理工作,充分发挥临床药师在抗菌药物应用中的作用,规范、合理、个体化、精准化使用抗菌药物,为患者更好地服务。

Evaluation of distribution of pathogenic bacteria and rational use of antimicrobial agents in patients with pneumoconiosis complicated by community-acquired pneumonia

Objective To analyze the distribution of pathogenic bacteria and rational use of antimicrobial agents in patients with pneumoconiosis complicated by community-acquired pneumonia.Methods There were 90 cases of pneumoconiosis with CAP without other history of chronic respiratory disease selected as the research group,and concurrent 90 cases of CAP without previous history of chronic respiratory disease selected as the control group.The status of pathogenic bacteria and drug-resistant bacteria,increase of leukocyte,neutrophil percentage,C-reactive protein,interleukin-6 and procalcitonin,use of antimicrobial agents were analyzed and compared between the two groups.Results The control group cultivated 6 strains of pathogenic bacteria,4 strains of bacilli,2 strains of cocci(Streptococcus pneumoniae),no fungus and drug-resistant bacteria.The research group cultivated 18 strains of pathogenic bacteria,14 strains of bacilli,1 strain of cocci(Streptococcus pneumoniae),3 strains of fungi(candida),including 3 strains of resistant bacteria,accounting for 16.67%of the pathogenic strains.The proportion of pathogenic bacteria 20.0%in the research group was higher than 6.67%in the control group,and the difference was statistically significant(χ^2=6.923,P<0.05).There was no significant difference in the proportion of drug-resistant bacteria between the two groups of pathogenic bacteria(χ^2=1.143,P>0.05).The increase rate of C-reactive protein and interleukin-6 in the research group before and after medication were 54.44%and 58.89%,respectively,which were all higher than 35.56%and 36.67%in the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in increase rate of leukocyte,neutrophil percentage and procalcitonin before and after medication between the two groups(P>0.05).There was no statistically significant difference in terms of oral,intravenous,single and combined use of antibiotics between the two groups(P>0.05).The medication duration of the research group>10 d accounted for 52.22%,which was higher than 27.78%of the control group,and the difference was statistically significant(P<0.05).The total utilization rate of first and second generation cephalosporins 32.22%in the research group was lower than 50.00%in the control group,and the difference was statistically significant(χ^2=5.875,P<0.05).The total utilization rate of third-generation cephalosporin and enzyme inhibitors 33.33%in the research group was higher than 8.89%in the control group,and the difference was statistically significant(χ^2=16.145,P<0.05).Conclusion The selection and course of treatment of antibacterial drugs for patients with pneumoconiosis and CAP are basically reasonable,but antimicrobial training and management work needs to be strengthened to give full play to the role of clinical pharmacists in the application of antibacterial drugs for standardize,rationalize,individualize and accurately use antibiotics,so as to better serve the pneumoconiosis patients.