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目的了解深圳市综合医院和结核病专科医院二线抗结核药物(second line anti-TBdrug,SLD)相关的抗菌药物使用情况,为其合理应用和科学管理提供可靠依据。方法调查2008年深圳市3家综合医院住院部呼吸内科、消化内科和泌尿内科3个科室245例病例,和1家结核病专科医院96例肺结核住院病例。均按不同科室内住院号顺序依次抽取病案资料查阅,分别记录使用的是SLD相关抗菌药物种类和时间段,并统计分析。结果综合医院,仅15.9%的病例有抗菌药物药物敏感试验,59.6%的病例使用过SLD相关的抗菌药物,以氟喹诺酮类居多,占49.8%,其次是大环内酯类,占9%;氟喹诺酮类的使用大多集中于左氧氟沙星和莫西沙星,而大环内酯类多集中于阿齐霉素和克拉霉素;呼吸内科应用较多,占75.1%。结核病专科医院96例肺结核病例中,65例为单纯肺结核病例,52%的病例合并使用SLD相关的抗菌药物,以氟喹诺酮类使用最多;31例合并其他细菌感染的肺结核病例,均使用了抗菌药物,且81%未做药物敏感试验,以氟喹诺酮类最多,占89%。氟喹诺酮类应用均以左氧氟沙星为主;氨基糖苷类抗菌药物应用较少。结论深圳市结核病专科医院存在较严重的结核病不规范治疗现象;综合医院和专科医院住院病例抗菌药物以经验用药为主,并均存在氟喹诺酮类和大环内酯类抗菌药物过多应用的现象。
Objective To understand the use of antimicrobial agents related to second-line anti-TBdrug (SLD) in Shenzhen General Hospital and Tuberculosis Hospital, so as to provide a reliable basis for its rational application and scientific management. Methods A total of 245 cases of respiratory department, gastroenterology and urology in inpatient department of 3 general hospitals in Shenzhen were investigated in 2008 and 96 cases of tuberculosis in a TB hospital. According to the different departments of the order number of hospitalized cases were taken for medical records, were recorded using SLD-related antimicrobial drugs types and time periods, and statistical analysis. Results In the general hospital, only 15.9% of the cases had antimicrobial drug susceptibility tests, and 59.6% of the cases used SLD - related antimicrobial drugs. The majority were fluoroquinolones, accounting for 49.8%, followed by macrolides, accounting for 9%. Fluoroquinolones were mostly used in levofloxacin and moxifloxacin, macrolides were mostly concentrated in azithromycin and clarithromycin; respiratory medicine applications, accounting for 75.1%. Among the 96 tuberculosis cases in TB hospital, 65 cases were simple tuberculosis cases and 52% cases were combined with SLD-related antibiotics, most frequently used fluoroquinolones. Among the 31 cases of tuberculosis complicated with other bacterial infections, antibiotics were used , And 81% did not make drug-sensitive test to fluoroquinolones, accounting for 89%. Fluoroquinolones were levofloxacin-based applications; aminoglycoside antibacterials less used. Conclusions There is a serious non-standard treatment of tuberculosis in Shenzhen TB Hospital. Inpatients of general hospitals and specialist hospitals are dominated by empirical medication, and there are some cases of excessive use of fluoroquinolones and macrolide antibiotics .