湖南省极低/超低出生体重儿抗生素使用多中心调查报告

A multicenter survey of antibiotic use in very and extremely low birth weight infants in Hunan Province

摘要:

目的 对湖南省新生儿病房极低出生体重（VLBW）和超低出生体重（ELBW）患儿住院期间抗生素使用情况进行调查，为规范湖南省新生儿病房住院早产儿抗生素的合理应用提供临床数据。方法 对湖南省24家三级医疗机构新生儿病房上报的2017年1~12月住院VLBW/ELBW患儿抗生素使用情况进行调查。结果 24家医疗机构2017年全年住院VLBW/ELBW患儿共1 442例，抗生素中位使用时间为17 d（范围：0~86 d），抗生素使用时间占住院时间的53.0%。各医疗机构抗生素使用时间占住院时间的百分比差异较大，最高达91.4%，最低为14.6%，2/3（16家）的单位超过50.0%。血及脑脊液细菌培养阳性共113例，细菌培养阳性率为7.84%，各机构细菌培养阳性率不同（0%~14.9%）。败血症常见致病菌中肺炎克雷伯杆菌检出29例（25.7%），大肠杆菌12例（10.6%），金黄色葡萄球菌3例（2.7%）。使用最多的抗生素为第三代头孢菌素类抗生素，占全部抗生素使用的41.00%；其次为青霉素类抗生素（32.10%），再次为碳青霉烯类抗生素（13.15%）。抗生素使用时间占比与出生体重Z值、出生体重与出院体重Z值的差值呈负相关（分别r_s=-0.095、-0.151，均P < 0.01），与病死/放弃率呈正相关（r_s=0.196，P < 0.01）。结论 湖南省新生儿病房住院VLBW/ELBW患儿抗生素使用时间较长，不同医疗机构抗生素使用情况差别大。第三代头孢菌素及碳青霉烯类抗生素使用比例较高。

Abstract:

Objective To investigate the current status of antibiotic use for very and extremely low birth weight (VLBW/ELBW) infants in neonatal intensive care units (NICUs) of Hunan Province. Methods The use of antibiotics was investigated in multiple level 3 NICUs of Hunan Province for VLBW and ELBW infants born between January, 2017 and December, 2017. Results The clinical data of 1 442 VLBW/ELBW infants were collected from 24 NICUs in 2017. The median antibiotic use duration was 17 days (range:0-86 days), accounting for 53.0% of the total length of hospital stay. The highest duration of antibiotic use was up to 91.4% of the total length of hospital stay, with the lowest at 14.6%. In 16 out of 24 NICUs, the antibiotic use duration was accounted for more than 50.0% of the hospitalization days. There were 113 cases with positive bacterial culture grown in blood or cerebrospinal fluid, making the positive rate of overall bacterial culture as 7.84%. The positive rate of bacterial culture in different NICUs was significantly different from 0% to 14.9%.The common isolated bacterial pathogens Klebsiella pneumoniae was 29 cases (25.7%); Escherichia coli 12 cases (10.6%); Staphylococcus aureus 3 cases (2.7%). The most commonly used antibiotics were third-generation of cephalosporins, accounting for 41.00% of the total antibiotics, followed by penicillins, accounting for 32.10%, and followed by carbapenems, accounting for 13.15%. The proportion of antibiotic use time was negatively correlated with birth weight Z-score and the change in weight Z-score between birth and hospital discharge (r_s=-0.095, -0.151 respectively, P < 0.01), positively correlated with death/withdrawal of care (r_s=0.196, P < 0.01). Conclusions Antibiotics used for VLBW/ELBW infants in NICUs of Hunan Province are obviously prolonged in many NICUs. The proportion of routine use of third-generation of cephalosporins and carbapenems antibiotics is high among the NICUs.