Borderon J C, Laugier J, Ramponi N, Saliba E, Gold F, Blond M H
Centre de Pédiatrie Gatien de Clocheville, Tours.
Ann Pediatr (Paris). 1992 Jan;39(1):27-36.
Since 1982, a pediatric intensive care unit for neonates and pediatric patients up to 15 years of age has prospectively recorded every instance of use of antimicrobials, with the reasons for use, clinical and bacteriological parameters, and outcome. This approach encourages strict adherence to established protocols and provides a basis for discussing the rationale of each antimicrobial course. Effectiveness of protocols is evaluated annually and modifications or additions are introduced, as appropriate. Patterns in the proportion and nature of antimicrobials used to treat hospital-acquired infections can be monitored on the basis of the data collected. Changes in the nature of antimicrobials used, which may have repercussions on pathogen resistance to antimicrobials, are also monitored. Reasons for use of antimicrobials are categorized as follows: A = primary infection: B = secondary infection acquired in the ICU; C: secondary infection acquired in another unit or in another hospital; D = prophylaxis. In 1987, 46% of neonates and 59% of patients above one month of age were given antimicrobial agents; these figures are similar to those recorded during the previous years. Reasons for antimicrobial therapy were as follows in neonates: A = 48.5%; B = 40%; C = 1.2%; D = 10.3%; in patients above one month of age corresponding figures were: A = 23%; B = 44%; C = 0.9%; D = 31.9%. Among the neonates, the ampicillin-aminoglycoside combinations accounted for 41.5% of treatments (1/4th of these treatments were continued); in the older patients, penicillin G and ampicillin were the most commonly used antibiotics. In all age groups, hospital-acquired infections were mainly respiratory tract infections (approximately 50% in neonates and 80% in patients above one month of age). Staphylococcus aureus was the most prevalent organism; Pseudomonas was seen virtually only among the patients above one month of age with very prolonged endotracheal intubation. From 1983 through 1987, use of third-generation cephalosporins increased from 4.5% to 28.3% in neonates and from 5.5% to 9% for patients above one month of age. The changes identified over time should be interpreted in the light of changing patterns of disease; in particular, hospital-acquired infections among neonates increased twofold, probably as a result of the rising number of very-low-birth-weight infants.
自1982年以来，一家为新生儿和15岁以下儿科患者设立的儿科重症监护病房前瞻性地记录了每一次抗菌药物的使用情况，包括使用原因、临床和细菌学参数以及治疗结果。这种方法鼓励严格遵守既定方案，并为讨论每个抗菌疗程的基本原理提供了依据。每年评估方案的有效性，并酌情进行修改或补充。根据收集的数据，可以监测用于治疗医院获得性感染的抗菌药物的比例和性质的模式。还监测抗菌药物使用性质的变化，这可能会对病原体对抗菌药物的耐药性产生影响。抗菌药物的使用原因分类如下：A = 原发性感染；B = 在重症监护病房获得的继发性感染；C = 在其他科室或其他医院获得的继发性感染；D = 预防。1987年，46%的新生儿和59%的1个月以上患者接受了抗菌药物治疗；这些数字与前几年记录的数字相似。新生儿抗菌治疗的原因如下：A = 48.5%；B = 40%；C = 1.2%；D = 10.3%；1个月以上患者的相应数字为：A = 23%；B = 44%；C = 0.9%；D = 31.9%。在新生儿中，氨苄西林 - 氨基糖苷类联合用药占治疗的41.5%（其中1/4的治疗持续进行）；在年龄较大的患者中，青霉素G和氨苄西林是最常用的抗生素。在所有年龄组中，医院获得性感染主要是呼吸道感染（新生儿中约为50%，1个月以上患者中约为80%）。金黄色葡萄球菌是最常见的病原体；铜绿假单胞菌实际上仅见于1个月以上且气管插管时间极长的患者。从1983年到1987年，新生儿中第三代头孢菌素的使用从4.5%增加到28.3%，1个月以上患者中从5.5%增加到9%。随着时间的推移所发现的变化应根据疾病模式的变化来解释；特别是新生儿中的医院获得性感染增加了两倍，这可能是极低出生体重儿数量增加的结果。
