抗菌药物管理策略的实施对我院综合ICU常见致病菌耐药性的影响
发布时间：2018-08-17 18:39
【摘要】：目的评估我院ICU中实施抗菌药物管理策略的效果,包括对抗菌药物使用情况及ICU常见致病菌耐药性的评估。方法我院自2011年8月份前后开始实施抗菌药物管理策略,包括分级预授权、限制应用、限制围手术期应用、总量控制。收集2010-2014年度病人的人口学和临床数据、抗菌药物使用强度、病人的初始抗菌药物选择、常见致病菌的耐药率。利用统计学方法对采集数据进行统计分析,达到评估持续实施抗菌药物管理策略以来,评估我院ICU抗菌药物使用情况变化,评估对我院ICU常见的5种致病菌,包括大肠埃希菌,肺炎克雷白杆菌,铜绿假单胞菌,鲍曼不动杆菌,金黄色葡萄球菌的耐药性的影响。结果从2010年至2013年,入ICU前接受抗菌药物治疗的比例明显下降,实施干预策略后,ICU总体抗菌药物使用强度明显下降,从2010年的163.46和2011年的190.01DDDs/100 patient-days下降为2012年的114.36和2013年的96.4DDDs/100 patient-days。抗菌药物使用构成显示,2010-2013年4年期间,其他β内酰胺类、氨基糖甙类、大环内酯类、喹诺酮类及咪唑类抗菌药物使用率明显下降,有统计学意义(P0.05)。2010-2013年4年期间,我们所监测的5种致病菌的耐药性有较大范围的改善。但是,2013年与2012年相比较,这5种致病菌的耐药状况改善并不广泛。除了鲍曼不动杆菌,只有大肠埃希菌对阿米卡星的耐药率、铜绿假单胞菌对环丙沙星的耐药率及金黄色葡萄球菌对苯唑西林的耐药率的改善具有统计学意义。肺炎克雷白杆菌的耐药没有明显改善,甚至出现肺炎克雷白杆菌对氨苄西林/舒巴坦的耐药率明显增加的情况。结论2010-2013年,.我院限制应用为主的抗菌药物管理实施后,ICU中抗菌药物消耗明显下降,使用构成趋于合理,常见致病菌的耐药性改善。但2013年耐药性的改善有放缓甚至反弹的趋势,抗菌药物管理的远期效果不明朗,可能通过抗菌药物管理以期望达到抗菌药物使用更为合理并延缓细菌耐药性恶化的目标更为现实。抗菌药物管理的临床效果需大范围和长时期的监测和评估。
[Abstract]:Objective to evaluate the effect of antimicrobial management strategy in ICU, including the use of antimicrobial agents and drug resistance of common pathogens of ICU. Methods the management strategy of antimicrobial agents was implemented in our hospital from August to August 2011, including graded pre-authorization, limited application, perioperative application, and total control. Collect the demographic and clinical data of patients from 2010 to 2014, the intensity of antimicrobial use, the initial antibiotic selection of patients, and the drug resistance rate of common pathogenic bacteria. The statistical method was used to analyze the collected data, to evaluate the changes of the use of ICU antibiotics in our hospital since the continuous implementation of antimicrobial management strategy, and to evaluate the five common pathogens of ICU in our hospital, including Escherichia coli. Antibiotic resistance of Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus. Results from 2010 to 2013, the proportion of patients receiving antimicrobial therapy before entering ICU decreased significantly, and the overall intensity of antimicrobial use decreased significantly after the intervention strategy, from 163.46 and 2011 190.01DDDs/100 patient-days in 2010 to 114.36 and 96.4DDDs/100 patient-days in 2012. The composition of antimicrobial use showed that the use of other 尾 -lactams, aminoglycosides, macrolides, quinolones and imidazoles decreased significantly during the 4-year period 2010-2013 (P0.05). The drug resistance of the five pathogens we monitored improved to a large extent. However, the resistance of these five pathogens was not widely improved in 2013 compared with 2012. Except for Acinetobacter baumannii, only Escherichia coli resistance to amikacin, Pseudomonas aeruginosa to ciprofloxacin and Staphylococcus aureus to oxacillin were significantly improved. The resistance of Klebsiella pneumoniae to ampicillin / sulbactam did not improve significantly, and the resistance rate of Klebsiella pneumoniae to ampicillin / sulbactam increased significantly. Conclusion from 2010 to 2013. After the limited use of antimicrobial agents was implemented in ICU, the consumption of antibiotics decreased significantly, the composition of use tended to be reasonable, and the drug resistance of common pathogenic bacteria was improved. But the improvement in drug resistance in 2013 has slowed or even rebounded, and the long-term effects of antimicrobial management are unclear. It is possible to achieve more rational use of antimicrobial agents and delay the deterioration of bacterial drug resistance through antimicrobial management. The clinical effect of antimicrobial drug management needs to be monitored and evaluated in a wide range and long-term.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5
本文编号：2188543
[Abstract]:Objective to evaluate the effect of antimicrobial management strategy in ICU, including the use of antimicrobial agents and drug resistance of common pathogens of ICU. Methods the management strategy of antimicrobial agents was implemented in our hospital from August to August 2011, including graded pre-authorization, limited application, perioperative application, and total control. Collect the demographic and clinical data of patients from 2010 to 2014, the intensity of antimicrobial use, the initial antibiotic selection of patients, and the drug resistance rate of common pathogenic bacteria. The statistical method was used to analyze the collected data, to evaluate the changes of the use of ICU antibiotics in our hospital since the continuous implementation of antimicrobial management strategy, and to evaluate the five common pathogens of ICU in our hospital, including Escherichia coli. Antibiotic resistance of Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus. Results from 2010 to 2013, the proportion of patients receiving antimicrobial therapy before entering ICU decreased significantly, and the overall intensity of antimicrobial use decreased significantly after the intervention strategy, from 163.46 and 2011 190.01DDDs/100 patient-days in 2010 to 114.36 and 96.4DDDs/100 patient-days in 2012. The composition of antimicrobial use showed that the use of other 尾 -lactams, aminoglycosides, macrolides, quinolones and imidazoles decreased significantly during the 4-year period 2010-2013 (P0.05). The drug resistance of the five pathogens we monitored improved to a large extent. However, the resistance of these five pathogens was not widely improved in 2013 compared with 2012. Except for Acinetobacter baumannii, only Escherichia coli resistance to amikacin, Pseudomonas aeruginosa to ciprofloxacin and Staphylococcus aureus to oxacillin were significantly improved. The resistance of Klebsiella pneumoniae to ampicillin / sulbactam did not improve significantly, and the resistance rate of Klebsiella pneumoniae to ampicillin / sulbactam increased significantly. Conclusion from 2010 to 2013. After the limited use of antimicrobial agents was implemented in ICU, the consumption of antibiotics decreased significantly, the composition of use tended to be reasonable, and the drug resistance of common pathogenic bacteria was improved. But the improvement in drug resistance in 2013 has slowed or even rebounded, and the long-term effects of antimicrobial management are unclear. It is possible to achieve more rational use of antimicrobial agents and delay the deterioration of bacterial drug resistance through antimicrobial management. The clinical effect of antimicrobial drug management needs to be monitored and evaluated in a wide range and long-term.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5
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