摘 要
儿科呼吸道感染是儿童常见疾病，抗生素的不合理使用导致耐药性问题日益严重。本研究旨在探讨抗生素在儿科呼吸道感染中的合理应用并分析耐药性情况。通过回顾性分析某三甲医院2018 - 2022年期间5岁以下确诊为呼吸道感染患儿的临床资料、病原学检查结果及抗生素使用情况，共纳入3046例患儿数据。结果显示，肺炎链球菌、流感嗜血杆菌和金黄色葡萄球菌为主要致病菌，其中肺炎链球菌对青霉素类、头孢菌素类等常用抗生素的耐药率分别为37.2%、29.8%，较之前有明显上升趋势；不同年龄、季节、地区间耐药性存在差异，年龄越小耐药性越高，冬季高于其他季节，城市地区高于农村地区。基于此提出合理应用策略：严格掌握适应证，根据药敏试验结果选择敏感药物，避免经验性用药，缩短疗程但确保足够剂量，同时加强健康宣教提高家长认知水平。本研究创新点在于结合多因素综合分析耐药性影响因素，并针对性地提出合理应用措施，为临床合理使用抗生素提供参考依据，有助于延缓耐药性的产生与发展，保障儿童健康。
关键词：儿科呼吸道感染；抗生素耐药性；合理用药
Abstract
Pediatric respiratory tract infections are common among children, and the irrational use of antibiotics has led to an increasingly serious problem of antibiotic resistance. This study aims to investigate the rational use of antibiotics in pediatric respiratory tract infections and analyze the antibiotic resistance situation. A retrospective analysis was conducted on clinical data, etiological examination results, and antibiotic usage of children under five years old diagnosed with respiratory tract infections at a tertiary hospital from 2018 to 2022, including a total of 3,046 cases. The results showed that Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus were the primary pathogens, with S. pneumoniae exhibiting resistance rates of 37.2% to penicillins and 29.8% to cephalosporins, showing a significant upward trend compared to previous data. Differences in antibiotic resistance were observed across different age groups, seasons, and regions, with higher resistance rates in younger children, during winter, and in urban areas compared to rural regions. Based on these findings, rational application strategies are proposed: strictly adhering to indications, selecting sensitive drugs based on susceptibility test results, avoiding empirical prescribing, shortening treatment duration while ensuring adequate dosage, and enhancing health education to improve parental awareness. The novelty of this study lies in its comprehensive analysis of multiple factors influencing antibiotic resistance and the targeted recommendations for rational use, providing reference for clinical practice to delay the emergence and development of resistance, thereby safeguarding children's health.
Keywords：Pediatric Respiratory Tract Infection；Antibiotic Resistance；Rational Drug Use
目 录
引 言 1
第一章 儿科呼吸道感染概述 2
1.1 呼吸道感染流行病学特征 2
1.2 主要病原体分布特点 2
1.3 抗生素使用现状分析 3
第二章 抗生素合理应用原则 4
2.1 用药指征的严格把握 4
2.2 经验性治疗的选择依据 4
2.3 病原学指导下的精准治疗 5
第三章 耐药性产生机制及影响 7
3.1 耐药菌株形成机理 7
3.2 不合理用药与耐药关联 7
3.3 耐药性对临床疗效的影响 8
第四章 合理用药策略与展望 10
4.1 规范化诊疗路径构建 10
4.2 抗菌药物管理措施 10
4.3 未来研究方向与建议 11
结 论 13
参考文献 14
致 谢 15
儿科呼吸道感染是儿童常见疾病，抗生素的不合理使用导致耐药性问题日益严重。本研究旨在探讨抗生素在儿科呼吸道感染中的合理应用并分析耐药性情况。通过回顾性分析某三甲医院2018 - 2022年期间5岁以下确诊为呼吸道感染患儿的临床资料、病原学检查结果及抗生素使用情况，共纳入3046例患儿数据。结果显示，肺炎链球菌、流感嗜血杆菌和金黄色葡萄球菌为主要致病菌，其中肺炎链球菌对青霉素类、头孢菌素类等常用抗生素的耐药率分别为37.2%、29.8%，较之前有明显上升趋势；不同年龄、季节、地区间耐药性存在差异，年龄越小耐药性越高，冬季高于其他季节，城市地区高于农村地区。基于此提出合理应用策略：严格掌握适应证，根据药敏试验结果选择敏感药物，避免经验性用药，缩短疗程但确保足够剂量，同时加强健康宣教提高家长认知水平。本研究创新点在于结合多因素综合分析耐药性影响因素，并针对性地提出合理应用措施，为临床合理使用抗生素提供参考依据，有助于延缓耐药性的产生与发展，保障儿童健康。
关键词：儿科呼吸道感染；抗生素耐药性；合理用药
Abstract
Pediatric respiratory tract infections are common among children, and the irrational use of antibiotics has led to an increasingly serious problem of antibiotic resistance. This study aims to investigate the rational use of antibiotics in pediatric respiratory tract infections and analyze the antibiotic resistance situation. A retrospective analysis was conducted on clinical data, etiological examination results, and antibiotic usage of children under five years old diagnosed with respiratory tract infections at a tertiary hospital from 2018 to 2022, including a total of 3,046 cases. The results showed that Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus were the primary pathogens, with S. pneumoniae exhibiting resistance rates of 37.2% to penicillins and 29.8% to cephalosporins, showing a significant upward trend compared to previous data. Differences in antibiotic resistance were observed across different age groups, seasons, and regions, with higher resistance rates in younger children, during winter, and in urban areas compared to rural regions. Based on these findings, rational application strategies are proposed: strictly adhering to indications, selecting sensitive drugs based on susceptibility test results, avoiding empirical prescribing, shortening treatment duration while ensuring adequate dosage, and enhancing health education to improve parental awareness. The novelty of this study lies in its comprehensive analysis of multiple factors influencing antibiotic resistance and the targeted recommendations for rational use, providing reference for clinical practice to delay the emergence and development of resistance, thereby safeguarding children's health.
Keywords：Pediatric Respiratory Tract Infection；Antibiotic Resistance；Rational Drug Use
目 录
引 言 1
第一章 儿科呼吸道感染概述 2
1.1 呼吸道感染流行病学特征 2
1.2 主要病原体分布特点 2
1.3 抗生素使用现状分析 3
第二章 抗生素合理应用原则 4
2.1 用药指征的严格把握 4
2.2 经验性治疗的选择依据 4
2.3 病原学指导下的精准治疗 5
第三章 耐药性产生机制及影响 7
3.1 耐药菌株形成机理 7
3.2 不合理用药与耐药关联 7
3.3 耐药性对临床疗效的影响 8
第四章 合理用药策略与展望 10
4.1 规范化诊疗路径构建 10
4.2 抗菌药物管理措施 10
4.3 未来研究方向与建议 11
结 论 13
参考文献 14
致 谢 15
