den Engelsen C, van der Werf C, Matute A J, Delgado E, Schurink C A M, Hoepelman A I M
Department of Internal Medicine and Infectious Diseases, University Medical Centre, PO Box 85500, F02.126, 3508 GA Utrecht, The Netherlands.
Int J Infect Dis. 2009 May;13(3):349-54. doi: 10.1016/j.ijid.2008.07.010. Epub 2008 Oct 26.
In order to develop guidelines for the use of antimicrobial agents, it is necessary to obtain detailed information on the prevalence of infectious diseases and antibiotic usage.
A retrospective study was conducted among outpatients with acute infections visiting the emergency department of the University Hospital of León, Nicaragua.
Over the course of one month, 2027 patients visited the emergency department. Seven hundred and thirty-two patients (36.1%) had an infection, with a total of 799 acute infections. The majority of patients (55.9%) were children. Respiratory tract infections (43.4%), urogenital infections (29.5%), and diarrhea or gastroenteritis of presumed infectious origin (8.8%) were the most frequent infections. Among respiratory tract infections, the most frequent diagnoses were community-acquired pneumonia (CAP; 31.4%), acute tonsillitis (28.2%), and the common cold (17.6%). CAP was treated with procaine benzylpenicillin in 70.6% of cases, whereas 84.0% of patients with acute tonsillitis were treated with a single dosage of benzathine benzylpenicillin intramuscularly. Among urogenital infections, the most frequent diagnosis was acute uncomplicated urinary tract infection (24.2%). Approximately a quarter of patients with uncomplicated urinary tract infections did not receive treatment according to the local guidelines. Of the patients with acute diarrhea, 27.1% were treated with antibiotics, while only a minority had leukocytes in Wright stain of the feces.
In conclusion our study shows that the use of antimicrobial agents is not optimal. Antibiotics were prescribed too often and not according to the local guidelines. This will further exacerbate the resistance problem in Nicaragua.
为制定抗菌药物使用指南，有必要获取关于传染病流行情况和抗生素使用的详细信息。
对尼加拉瓜莱昂大学医院急诊科就诊的急性感染门诊患者进行回顾性研究。
在一个月的时间里，有2027名患者到急诊科就诊。732名患者（36.1%）发生感染，共出现799例急性感染。大多数患者（55.9%）为儿童。呼吸道感染（43.4%）、泌尿生殖系统感染（29.5%）以及推测为感染性病因的腹泻或胃肠炎（8.8%）是最常见的感染类型。在呼吸道感染中，最常见的诊断为社区获得性肺炎（CAP；31.4%）、急性扁桃体炎（28.2%）和普通感冒（17.6%）。70.6%的CAP病例使用普鲁卡因苄星青霉素治疗，而84.0%的急性扁桃体炎患者接受单次剂量的苄星青霉素肌肉注射治疗。在泌尿生殖系统感染中，最常见的诊断为急性单纯性尿路感染（24.2%）。约四分之一的单纯性尿路感染患者未按照当地指南接受治疗。在急性腹泻患者中，27.1%接受了抗生素治疗，而粪便瑞氏染色显示仅有少数患者有白细胞。
总之，我们的研究表明抗菌药物的使用并不理想。抗生素处方过于频繁且未遵循当地指南。这将进一步加剧尼加拉瓜的耐药问题。
