教学医院不合理应用抗菌药物治疗成人急性感染性腹泻调查

教学医院不合理应用抗菌药物治疗成人急性感染性腹泻调查

侯凤琴, 孙新婷, 王贵强^*

北京大学第一医院感染疾病科, 北京 100034

收稿日期:2010-02-23 修回日期:2010-04-15 出版日期:2010-05-15 发布日期:2010-05-15
通讯作者: 王贵强*

Inappropriate use of empirical antibiotics in adults with acute infectious diarrhea in a large teaching hospital

Feng-Qin Hou, Xin-Ting Sun, Gui-Qiang Wang^*

Department of Infectious Diseases, Peking University First Hospital, Beijing 100034, China

Received:2010-02-23 Revised:2010-04-15 Online:2010-05-15 Published:2010-05-15
Contact: Gui-Qiang Wang*

摘要/Abstract

摘要： 临床滥用抗生素治疗腹泻现象非常普遍, 但该方面报道很少。我们回顾性调查我院2008年4月至2009年10月成人肠道门诊4891例急性感染性腹泻患者的临床诊治情况, 发现其中30.5%临床支持侵袭性细菌腹泻, 48.1% 应用了抗生素治疗, 不合理应用抗生素为20.3%, 其中19%为非适应症使用了抗生素, 占总使用抗生素的39.4%。在不合理使用抗生素方面, 上级医师 (主治医师和副主任医师) 与住院医师没有差别 (P = 1.0)。Logistic 回归分析显示除了体温、腹痛、里急后重及便白细胞计数 >10 个/HPF与抗生素应用密切相关外, 呕吐 (OR 1.25, 95% CI 1.06-1.48), 排便次数 5~10 次/天 (OR 1.21, 95% CI 1.03-1.41), 粘液便 (OR 2.03, 95% CI 1.40-2.94), 便白细胞计数 1~10 个/HPF (OR 2.59, 95% CI 2.05-3.28) 也与抗生素应用密切相关, 而这四种表现正常情况下不是抗生素应用的指症, 可能临床医生误把这四种表现作为了侵袭性腹泻的特征, 从而导致了抗生素的过度应用。

关键词: 急性感染性腹泻, 抗生素, 不合理应用

Abstract:

Overuse of antibiotics for the treatment of acute diarrhea is very common. The aim of the current study was to investigate the inappropriate use of antibiotics in adults with acute infectious diarrhea and to evaluate the association between the use of antibiotics and clinical features. To achieve this aim, we reviewed 4891 patients’ medical records from Apr. 2008 to Oct. 2009. Of the total 4891 cases, 30.5% had clinical features of invasive bacterial diarrhea, 48.1% were prescribed with antibiotics,and 20.3% received inappropriate antibiotic treatment. Of note, 19% involved unnecessary antibiotic prescriptions in non-indicated cases, which accounted for 39.4% of all antibiotics prescribed in the total 4891 patients. There was no significant differences between physicians and medical trainees in the inappropriate use of antibiotics (P = 1.0). Logistic regression analysis demonstrated that except for body temperature, other clinical symptoms including abdominal pain, tenesmus, and faecal WBC count (>10 cells/HPF) were associated with the use of antibiotics. In addition, other clinical indicators including vomiting, stool frequency of 5–10 times/d, mucous stool, and fecal WBC count of 1-10 cells/HPF, which are not normally indicators for prescribing antibiotics, were also associated with the use of antibiotics. This might suggest that these symptoms were mistaken as features of invasive bacterial diarrhea, thus leading to the overuse of antibiotics.

Key words: Acute infectious diarrhea, Antibiotics, Inappropriate use

中图分类号:

R978

Supporting:

Foundation items: This work was Funded by National "863" Program (Grant No. 2006AA020703) and Beijing Key Project (Grant No. D0206010041091).

^*Corresponding author. Tel.: 86-10-83572362, 13911405123; fax: 86-10-66551680

侯凤琴, 孙新婷, 王贵强^*. 教学医院不合理应用抗菌药物治疗成人急性感染性腹泻调查[J]. .

Feng-Qin Hou, Xin-Ting Sun, Gui-Qiang Wang^*. Inappropriate use of empirical antibiotics in adults with acute infectious diarrhea in a large teaching hospital [J]. .

参考文献

[1] Kosek, M.; Bern, C.; Guerrant, R.L. Bull. World Health Organ. 2003, 81, 197-204.
[2] Bern, C.; Martines, J.; de Zoysa, I.; Glass, R.I. Bull. World Health Organ. 1992, 70, 705-714.
[3] World Health Organization. Geneva: Who, 2005, WHO/CDD/SER/80.2.
[4] Rosen, P. ed. Emergency Medicine: Concepts and Clinical Practice. Bitterman RA. Acute gastroenteritis and constipation. 4th edn. St Louis, MO: Mosby-Year Books. 1998, 1917-1958.
[5] Sadosty, A.T.; Browne, B.J. Vomiting, Diarrhea, and Constipation. In: Tintinalli, J.E.; Kelen, G.D.; Stapcynski, J.S. eds. Emergency Medicine. A Comprehensive Guide. 5th edn. New York: McGraw-Hill. 2000, 567-574.
[6] Osatakul, S.; Puetpaiboon, A. Ann. Trop. Paediatr. 2007, 27, 115-122.
[7] Howteerakul, N.; Higginbotham, N.; Dibley, M.J. Southeast Asian J. Trop. Med. Public Health. 2004, 35, 181-187.
[8] Alam, M.B.; Ahmed, F.U.; Rahman, M.E. Bangladesh Med. Res. Counc. Bull. 1998, 24, 27-31.
[9] Rowe, A.K.; Onikpo, F.; Lama, M.; Cokou, F.; Deming, M.S. Am. J. Public Health. 2001, 91, 1625-1635.
[10] Boonstra, E.; Lindbaek, M.; Ngome, E. Int. J. Qual. Health Care. 2005, 17, 221-227.
[11] Bijalil, R.; Calva, J.J. J. Clin. Epidemiol. 1994, 47, 147-156.
[12] Hoge, C.W.; Gambel, J.M.; Srijan, A.; Pitarangsi, C.; Echeverria, P. Clin. Infect. Dis. 1998, 26, 341-345.
[13] Stoll, B.J.; Glass, R.I.; Banu, H.; Huq, M.I.; Khan, M.U.; Ahmed, M. Br. Med. J. 1983, 286, 2037-2040.

[14] Yu, A.H. China Med. Tribune. 2004, 30, 5.
[15] Wang, J.F.; Zhang, W.J.; Huang, F.M. China Pharmacy. 2005, 16, 1649-1650.
[16] Yu, W.L. Chin. J. Epidemiol. 1990, 11, 341-344.
[17] Lucy Reynolds.; Martin McKee. Health Policy. 2008, doi:10.1016/j.healthpol.2008.09.002.
[18] Osatakul, S.; Tangadullart, C. Songkla Med. J. 1999, 17, 25-30.
[19] Gaur, A.H.; Hare, M.E.; Shorr, R.I. Pediatrics. 2005, 115, 635-641.
[20] Ismail, R.; Bakri, A.; Nazir, M.; Ryanto, Haridawati. J. Diarrheal. Dis. Res. 1994, 12, 208-213.
[21] Johnson, L.R.; Christensen, J.; Jacobson, E.D.; Jackson, M.J.; Walsh, J.H. Physiology of the Gastrointestinal Tract. Neutra, M.R.; Forstner, J.F. Gastorintestinal Mucus: Synthesis, Secretion, and Function, 2^nd den. New York: Raven Press, 1987, 975-1011.