深圳市住院病人抗结核相关抗菌药物应用调查

摘要/Abstract

摘要： 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-TB drug，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。

关键词: 抗生素类, 抗结核, 荧光喹诺酮类, 大环内酯类, 医院, 专科, 医院, 综合

Abstract: Objective To investigate the antibiotic application related to anti-TB second-line drug (SLD)in general hospitals and TB specialist hospital in Shenzhen, and to provide a reliable basis for rational use of antibiotics and their scientific management. Methods Three general hospitals，including 245 inpatient cases from respiratory disease, digestive and urologic departments，and 96 cases fromTB special hospital were investigated in order to understand their application of antibiotic related to anti-Tuberculosis SLD. Cases were selected sequentiallyby their inpatient record number and investigated by recording the types and time period of applied antibiotic related to anti-tuberculosis second line drugs（SLD）. Results Only 15.9% of all inpatient cases had drug susceptibility test, and 59.6% of cases had ever applied antibiotic related to anti-tuberculosis second line drugs. The majority applied Fluoroquinolone, accounting for 49.8%, followed by Macrolides, accounting for 9%. Fluoroquinolone classes are mostly focused on the use of levofloxacin and moxifloxacin, while the macrolides are more concentrated in azithromycin and clarithromycin; Department of Respiratory Medicine used more often, accounting for 75.1%. Among 96 cases of PTB from TB special hospital, 65 cases of them are diagnosed as PTB without other bacterial infection, and 52% of them combined use of second line anti-TB drugs; 31 cases of PTB complicating with other bacterial infection all applied SDL, and 81% of them had no DST Results . The majority applied Fluoroquinolone, accounting for 89%, and focused on Levofloxacin. Aminoglycoside antibiotics is seldom used. Conclusion s The PTB treatment is not standard in TB special hospital. Use of antibiotic was more of empiric-based. Fluoroquinolone and Macrolides were excessively used both in general and TB special hospitals in Shenzhen.

Key words: antibiotics,antitubercular, fluoroquinolones, macrolides, hospitals,special, hospitals,general

许丽, 杨应周, 吴清芳, 管红云, 张玉华, 李明珍. 深圳市住院病人抗结核相关抗菌药物应用调查[J]. 中国防痨杂志, 2010, 32(3): 151-154.

Xu Li,Yang Yingzhou,Wu Qingfang,Guan Hongyun,Zhang Yuhua,Li Mingzhen. Antibiotic application related to anti-tuberculosis second line drugs in general hospitals and TB special hospital in Shenzhen[J]. Chinese Journal of Antituberculosis, 2010, 32(3): 151-154.

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