2011—2015年住院患者抗菌药物使用强度与分离病原菌耐药性变化

发布时间：2018-06-23 00:21

本文选题：病原菌 + 抗菌药物　；参考：《中国感染控制杂志》2017年08期

【摘要】：目的了解2011—2015年抗菌药物专项整治前后常见病原菌分布及耐药性变迁,为指导抗菌药物临床应用提供依据。方法收集2011—2015年某院住院患者抗菌药物使用情况及患者分离病原菌,分析主要病原菌对常见抗菌药物的耐药率变化趋势。结果2011—2015年住院患者抗菌药物使用率从75.84%下降至37.35%,抗菌药物使用强度从59.53/(100例患者·d)下降至33.63/(100例患者·d),均呈下降趋势(均P0.05)。共分离病原菌10 091株,其中革兰阳性菌2 338株,占23.17%;革兰阴性菌7 110株,占70.46%;真菌643株,占6.37%。居前5位的病原菌为大肠埃希菌(20.85%)、肺炎克雷伯菌(15.90%)、铜绿假单胞菌(11.70%)、金黄色葡萄球菌(7.35%)和鲍曼不动杆菌(6.82%)。主要病原菌对常用抗菌药物耐药率呈下降趋势,其中大肠埃希菌和肺炎克雷伯菌对哌拉西林/他唑巴坦、头孢西丁、阿米卡星的耐药率下降最明显(2015年均4%);铜绿假单胞菌较鲍曼不动杆菌对常用抗菌药物的敏感性整体较高,对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢他啶、头孢吡肟、阿米卡星、环丙沙星耐药率下降明显,对上述药物的耐药率20%,对碳青霉烯类抗生素的耐药率高于其他常用药物;鲍曼不动杆菌对阿米卡星、左氧氟沙星耐药率下降最明显,但对美罗培南、亚胺培南耐药率明显上升,至2015年,耐药率均50%。金黄色葡萄球菌对氟喹诺酮类药物耐药率下降最明显(2%),未见耐万古霉素菌株。结论常见病原菌的耐药率随着抗菌药物专项整治后抗菌药物使用量的下降均有不同程度的下降,抗菌药物合理使用与延缓细菌耐药可能有关。
[Abstract]:Objective to investigate the distribution of common pathogens and the changes of drug resistance before and after the special treatment of antimicrobial agents from 2011 to 2015, so as to provide the basis for guiding the clinical application of antimicrobial agents. Methods the use of antimicrobial agents and the isolation of pathogens from inpatients in a hospital from 2011 to 2015 were collected and the trend of resistance of main pathogens to common antimicrobial agents was analyzed. Results from 2011 to 2015, the utilization rate of antibiotics decreased from 75.84% to 37.35%, and the intensity of antimicrobial use decreased from 59.53 / (100 patients d) to 33.63 / 100 cases (all P0.05). A total of 10 091 strains of pathogenic bacteria were isolated, of which 2 338 were Gram-positive bacteria (23.17%), 7 110 were Gram-negative bacteria (70.46) and 643 were fungi (6.37%). The top 5 pathogens were Escherichia coli (20.85%), Klebsiella pneumoniae (15.90%), Pseudomonas aeruginosa (11.70%), Staphylococcus aureus (7.35%) and Acinetobacter baumannii (6.82%). The resistance rate of major pathogens to common antimicrobial agents showed a decreasing trend, in which Escherichia coli and Klebsiella pneumoniae were resistant to piperacillin / tazobactam, cefoxitin, and other bacteria. The resistance rate of amikacin was the most obvious (4% in 2015), Pseudomonas aeruginosa was more sensitive to common antibiotics than Acinetobacter baumannii, and was more sensitive to piperacillin / tazobactam, cefoperazone / sulbactam, ceftazidime, cefepime, ceftazidime and cefepime. The resistance rate of amikacin and ciprofloxacin to ciprofloxacin decreased significantly, the resistance rate to carbapenem antibiotics was higher than that to carbapenem antibiotics, and the resistance rate of Acinetobacter baumannii to amikacin and levofloxacin was the most obvious. But the rates of resistance to meropenem and imipenem increased significantly, and by 2015, the drug resistance rates were 50%. The resistance rate of Staphylococcus aureus to fluoroquinolones was the most obvious (2%), but no vancomycin resistant strain was found. Conclusion the drug resistance rate of common pathogens decreased with the decrease of antimicrobial use after special treatment of antimicrobial agents. Rational use of antimicrobial agents may be related to delaying the drug resistance of bacteria.
【作者单位】：东营市人民医院;
【分类号】：R446.5

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