儿科重症监护病房抗菌药使用的多中心流行病学调查

【目的】了解并评估中国5家教学儿童医院儿科重症监护病房（pediatric intensive care unit,PICU）抗菌药使用情况,建立适合我国国情的儿科医院PICU抗菌药使用初步评估体系。【方法】首先调查2002-2006年5家教学儿童医院PICU所有12 743患儿的情况,然后抽查北京、重庆以及复旦儿童医院PICU,均观察以下指标：一般情况、临床资料、抗菌药使用、细菌学检查等。【结果】5家儿童医院2002-2006年收住患儿的住院时间没有明显变化;PICU抗菌药使用的费用占总的药物使用费用的比率均有下降的趋势。在抗菌药使用指征上,各医院PICU还是以经验性治疗为主,但从2002-2006年,经验性治疗在逐年降低,而针对性治疗在逐年升高。540份抽查病例显示：524（97%）例患儿至少使用了一种抗菌药,经验性治疗占71.6%。第三代头孢菌素使用最多（31%）。北京、重庆、复旦的病原菌分离率分别为29%,66%和67%。其中,6种常见的细菌占分离菌的77.2%。大肠埃希菌耐头孢噻肟的耐药率在北京、重庆、复旦分别为73.8%、58.3%和49.2%,北京儿童医院均高于其他2家儿童医院（P=0.00）。【结论】本研究调查得出了5家儿童医院PICU抗菌药使用的基本数据。所抽查的3家医院PICU在抗菌药使用上均存在不同程度的不合理性;由于送检标本的检出率低,所以病原学的结果在指导抗菌药针对性使用上也受到限制。

Survey on antmicrobial usage in pediatric intensive care units in multicentre

【Objective】 To demonstrate the antibiotic usage in five Chinese pediatric intensive care units（PICUs）,and provide some data for further study on antimicrobial usage.【Methods】 A total of 12 743 patients from five PICUs of Chinese teaching children hospitals from 2002 to 2006 were included in this study.Then data were equally collected from 540 charts of three PICUs in 2006.The data included demographic,clinical data and those on antimicrobial usage and results of microbiological examinations.【Results】 Length of stay in PICUs was essentially unchanged,but the percentage of antimicrobial costs vs.drug costs decreased from 2002 to 2006.The percentage of empiric treatment decreased by year,while the percentage of therapeutic treatment increased by year.Of the 540 cases,524（97%） patients received at least one antimicrobial agent.The main treatment started empirically in 387（71.6%）.The third generation cephalosporins were the major antimicrobials used in all participating hospitals,accounting for 227（31%）.Bacteria were isolated from 29%,66% and 67% of the three PICUs.Six common pathogens accounted for more than 77.2% of the isolated bacteria.The rates of Escherichia coli isolates resistant to cefotaxime were 73.8%,58.3% and 49.2%,respectively,in Beijing,Chongqing and Fudan,with the rate being higher in Beijing than in Chongqing and Fudan（both P=0.00）.【Conclusion】 In This retrospective study offers some data on the antimicrobial usage in five PICUs in China.Irrational use of antimicrobials exists in clinical practice of PICUs in China.Moreover,it is limited to guide to therapeutic treatment by limited evidence of bacteriology.