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当前位置：国际儿科研究杂志 > 2024年 4卷 (2)期

Open Access Article

International Journal of Pediatrics Research. 2024; 4: (2) ; 13-21 ; DOI: 10.12208/j.ijped.20240012.

Research on the rational use of antibiotics and resistance management strategies in pediatrics
儿科抗生素合理使用与耐药管理策略研究

作者： 周文浩 *

重庆医科大学重庆

*通讯作者：周文浩,单位：重庆医科大学重庆；

发布时间: 2024-12-31 总浏览量: 212

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摘要

抗生素耐药性已成为全球公共卫生的重大威胁，而儿科患者由于免疫系统发育不完善、药物代谢特点特殊，其抗生素合理使用与耐药管理面临严峻挑战。本研究旨在系统分析儿科抗生素使用现状，评估耐药菌流行趋势，并探讨有效的抗菌药物管理策略（Antimicrobial Stewardship Program, ASP），以优化临床实践并减缓耐药性发展。研究采用多中心回顾性分析方法，整合来自不同医疗机构的临床数据，结合人工智能（AI）辅助决策系统，评估抗生素处方合理性及耐药菌感染的危险因素。结果显示，实施ASP可显著降低儿科患者抗生素使用强度（DDD值下降18.7%）和耐药率（如肺炎克雷伯菌对第三代头孢菌素的耐药率降低23.1%）。此外，AI临床决策支持系统（如KINBIOTICS）的应用可提高抗生素选择的准确性，减少不必要的广谱抗生素使用（OR=0.62, 95%CI 0.51-0.75）。研究还发现，重症监护病房（PICU）患儿是多重耐药菌（如CRE、MRSA）感染的高危人群（P<0.01），而规范化的感染防控措施可降低医院获得性耐药菌感染风险达34.5%。本研究的创新点在于结合最新临床数据（2023-2024年）和智能决策技术，提出基于循证医学的儿科抗生素管理优化策略。研究结果提示，未来应加强多学科协作的ASP项目，推广AI辅助决策系统，并针对高危患儿实施精准化感染防控措施，以有效遏制耐药菌的传播。

关键词： 儿科；抗生素耐药；抗菌药物管理；多重耐药菌；肺炎克雷伯菌；ESKAPE病原体；AI决策

Abstract

Rational Use of Antibiotics and Resistance Management Strategies in Pediatrics Antibiotic resistance has become a major global public health threat, and pediatric patients face significant challenges in antibiotic stewardship due to their immature immune systems and unique pharmacokinetics. This study aimed to analyze the current status of antibiotic use in pediatrics, assess the trends of resistant pathogens, and explore effective antimicrobial stewardship strategies to optimize clinical practice and mitigate resistance development.Using a multicenter retrospective analysis combined with AI-based clinical decision support systems (CDSS), we evaluated antibiotic prescribing patterns and risk factors for resistant infections. The results demonstrated that implementing an Antimicrobial Stewardship Program (ASP) significantly reduced antibiotic consumption (18.7% decrease in DDD) and resistance rates (e.g., a 23.1% decline in third-generation cephalosporin resistance in Klebsiella pneumoniae). AI-assisted decision systems (e.g., KINBIOTICS) improved antibiotic selection accuracy and reduced unnecessary broad-spectrum use (OR=0.62, 95%CI 0.51-0.75). Furthermore, pediatric intensive care unit (PICU) patients were at higher risk for multidrug-resistant infections (e.g., CRE, MRSA; P<0.01), while standardized infection control measures reduced hospital-acquired resistant infections by 34.5%.This study integrates the latest clinical data (2023-2024) and AI-driven approaches to propose evidence-based optimization strategies for pediatric antibiotic management. The findings highlight the need for multidisciplinary ASP initiatives, AI-assisted decision-making, and targeted infection prevention measures in high-risk populations to curb the spread of resistant pathogens.

Key words： Pediatrics; Antibiotic resistance; Antimicrobial stewardship; Multidrug-resistant organisms (MDROs); Klebsiella pneumoniae; ESKAPE pathogens; AI decision support

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引用本文

周文浩, 儿科抗生素合理使用与耐药管理策略研究[J]. 国际儿科研究杂志, 2024; 4: (2) : 13-21.

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