| Objectives(1)To verify the feasibility of collecting samples of patients with acute respiratory tract infection in village clinics/township hospitals for microbiological test;(2)To evaluate the bacterial test rate and types,drug resistance test rate and types of outpatient patients at rural areas,and to compare the differences of pathogens and drug resistance test results among different groups;(3)To study the relationship between microbiological test results(including pathogen and drug resistance),clinical treatment and antimicrobial use,and symptoms of patients.Methods(1)Recruited Patients in Leqiao Town of Lujiang County and Cao'an Town of Huainan City by continuous sampling,and simultaneously in a pilot township hospital and a village clinic;(2)All eligible outpatients were recruited and the samples were collected,transported,inoculated and cultured according to the standardized procedure,after the samples were collected,the patients were investigated by structured exit questionnaires;(3)Draw coping pathway of acute respiratory tract infection,SPSS19.0software was used to analyze the data,the main methods were descriptive analysis,chi-square test and logistic regression analysis.Results(1)A total of 852 patients with acute respiratory tract infections were recruited;(2)The average symptoms number of acute respiratory tract infection was(4.33 ± 0.06)and the average number of uncomfortable days was(9.29 ± 1.22)days,the frequency of common symptoms was sore throat(53.6%)> cough with white phlegm(48.1%)>runny nose(26.5%)> cough with yellow phlegm(26.1%).(3)224(26.3%)residents took measures by themselves before consulting,and only 25(2.9%)residents used drugs containing antibiotics.(4)The younger,highly educated patients and patients in Lujiangarea are more likely to take measures by themselves.(5)276 cases of bacteria were tested account for 32.4% test rate,the top five bacteria were Enterobacteriaceae(36.6%)>Haemophilus influenzae(16.3%)> Haemophilus parainfluenzae(14.1%)>Staphylococcus(5.8%)> Pseudomonas aeruginosa(5.8%).Multivariate logistic regression analysis showed that men and were more likely to test bacteria than women;The seasonal order of bacteria easily tested was spring > winter > summer;patients with older age,longer uncomfortable days,more symptoms and fever symptoms,easier to test bacteria.(6)214 cases of drug resistance were tested account for 77.5% test rate,The top six drug resistance types were ampicillin(62.6%)> compound trimethoprim(23.4%)> cefazolin(21.0%)> cefotetan(11.2%)> cefmetazole(7.0%)> cefuroxime(7.0%).Multivariate logistic regression analysis showed that men and were more likely to test drug resistance than women;The seasonal order of drug resistance easily tested was spring > summer > winter;patients with longer uncomfortable days,more symptoms and fever symptoms,easier to test drug resistance.(7)The self-reported use of antibiotics by residents(49.8%)was lower than the actual use of prescriptions(88.3%).(8)Among the 852 recruited patients,752 were using antibiotics,of which 241 were tested for bacterial infections and 511 were not;The use rate of antibiotics was 88.7% in the patients with negative bacterial test,and there was no difference between the positive and negative groups in the use rate of antibiotics.total of852 patients with acute respiratory tract infections were recruited;(2)Descriptive analysis of symptoms of acute respiratory tract infection showed that the average number of symptoms was(4.33 ± 0.06)and the average number of uncomfortable days was(9.29 ± 1.22)days.The frequency of common symptoms was sore throat > cough with white phlegm > runny nose > cough with yellow phlegm;(3)The path map of coping style of acute respiratory tract infection showed that 224(26.3%)residents took measures before visiting the doctor.Only 25(2.9%)residents used drugs containing antibiotics.820 received medical treatment and 752 people used antibiotics;(4)Theanalysis of influencing factors of coping behavior of patients showed that those with higher education level were more likely to adopt coping measures on their own than those with lower education level,Lujiang area was more likely than Huainan area and had similar disease experience in the past year;(5)The analysis of influencing factors of antimicrobial treatment showed that the older the age and the shorter the uncomfortable days,the easier the doctors to prescribe antimicrobial drugs;compared with Township hospitals,the doctors in village clinics were more likely to prescribe antimicrobial drugs;(6)The results of pathogen detection showed that 276 bacteria were detected,the detection rate was 32.4%.The top five bacteria were Enterobacteriaceae > Haemophilus influenzae > Haemophilus parainfluenzae > Staphylococcus > Pseudomonas aeruginosa.Multivariate logistic regression analysis showed that the seasonal order of bacteria easy to detect was spring > winter > summer;the longer uncomfortable days,the easier to detect bacteria;(7)The results of antimicrobial resistance test showed that 214 cases had drug resistance,the detection rate was 25.1%.Ampicillin > Compound Xinnuoming >Cefazolin > Ceftitam > Cefmetazole > Cefuroxime were the most common drug resistance.Multivariate logistic regression analysis showed that men were more likely to detect drug resistance than women;the seasonal order of drug resistance was spring >summer > winter;the longer uncomfortable days,the easier to detect drug resistance;fever symptoms,no sore throat / burning sensation symptoms were more likely to detect drug resistance;(8)Cognition of antibiotics and consistency of prescriptions among residents showed that 752(88.3%)of the prescriptions prescribed by doctors contained antibiotics.There were 411(97.2%)patients with antimicrobial drugs in the prescription.The results of consistency test showed that there was significant difference between them(P < 0.05);(9)The rationality of antimicrobial use by doctors showed that 752 of the 852 recruited patients used antimicrobial drugs,of which 241 detected bacterial infection,accounting for 32.0%.No bacterial infection was detected in 511 people,accounting for 68.0%.Conclusions(1)It is feasible to collect patients' specimens in township hospitals and village clinics to send them to a higher level hospital for microbiological testing.(2)The unreasonable use of antibiotics in township hospitals and village clinics is serious.(3)The main measure for residents after illness is self-medication;the proportion of prescriptions of antibiotics prescribed by doctors is high.(4)Enterobacteriaceae was the most frequently detected bacteria;Male,old age,long uncomfortable days and more symptoms are the "prompting factors" of bacterial positive that should be noticed when send for examination,seasonal influence suggests that the external environment of inspection should be paid attention to.(5)The detection rate of drug resistance is high,the most common type of drug resistance is ampicillin;Possible factors affecting drug resistance include gender,season,days of discomfort,specific symptoms and number of symptoms. |
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