Study on the use of antimicrobial agents in hospitalized trauma patients based on medical big data
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摘要: 目的 探讨创伤严重度与抗菌药物使用的关系，为创伤抗菌药物临床应用和战伤救治药材标准制订提供参考依据。 方法 采取国际疾病分类编码第10版（ICD-10）与简明创伤评分（AIS）对照关联的方法，将ICD-10中创伤诊断编码进行创伤严重度评分分级，统计分析不同创伤评分住院患者抗菌药物使用情况。 结果 共纳入25 035例，按照AIS分值由轻到重依次划分为1、2、3、4、5共5组，5组患者占总病例的比例分别为21.92%、67.73%、8.86%、0.97%和0.52%；以第二代头孢菌素、第三代头孢菌素、第一代头孢菌素、氟喹诺酮类和青霉素（β-内酰胺酶抑制剂）类为主的复方用药最多，分别占抗菌药物总DDDs的29.69%、22.57%、20.33%、4.66%和4.47%；使用率排名前10位的品种是头孢呋辛（12.21%）、头孢唑啉（8.31%）、头孢曲松（7.74%）、头孢硫脒（7.34%）、头孢替安（4.87%）、头孢孟多酯（3.68%）、阿莫西林克拉维酸（3.63%）、左氧氟沙星（3.59%）、头孢西丁（3.56%）和氟氯西林（3.52%）；庆大霉素（2.27%）、奥硝唑（2.00%）和头孢哌酮他唑巴坦（1.44%）在各自药理学类别中也使用最多。不同创伤评分的住院患者抗菌药物使用品种和数量均不同。 结论 基于ICD-AIS的创伤评分较好地反映了住院患者创伤严重程度，不同创伤评分的住院患者抗菌药物使用品种、剂量均有差异，为创伤抗菌药物临床应用和战伤救治药材标准制订提供了参考。Abstract: Objective To investigate the relationship between the trauma severity and the usage of antibacterial drugs and to provide reference for standard protocol of proper antibiotic use in wound care. Methods ICD-10 and AIS were used to set up the relationship and to analyze the use of antibiotics in patients with different trauma score. Results 25 035 trauma patients were enrolled in this study. Those patients were divided into five groups according to the AIS score with least severe as group 1 to most severe as group 5. The patient percentage in group 1 to 5 was 21.92%,67.73%,8.86%,0.97% and 0.52% respectively. The five most frequently used antibiotic classes are second generation cephalosporins,third generation cephalosporins,first generation cephalosporins,fluoroquinolones and penicillin/beta lactamase inhibitor combination, accounted for 29.69%,22.57%,20.33%,4.66% and 4.47% of total DDDs of antibacterial drugs. Individually, the top 10 antibiotics are cefuroxime (12.21%), cefazolin (8.31%), ceftriaxone (7.74%), cefathiamidine (7.34%), cefotiam (4.87%), ceftazidime (3.68%), amoxicillin/clavulanic acid (3.63%), levofloxacin (3.59%), cefoxitin (3.56%), flucloxacillin (3.52%); gentamicin (2.27%), ornidazole (2.00%) and cefoperazone/tazobactam (1.44%) were used most in their categories respectively. The variety and quantity of antibacterial drugs used for different trauma patients were different. Conclusion The trauma score based on ICD-AIS can reflect the severity of trauma. The use of antibiotics in patients with different trauma score can provide reference for the clinical applications of antibiotics in wound care.
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Key words:
- trauma score /
- medical big data /
- antibacterial drugs /
- drug use
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