我国细菌耐药性的分布与控制策略研究

发布时间：2018-04-01 13:19

本文选题：耐药性　切入点：分布　出处：《华中科技大学》2007年硕士论文

【摘要】： 目的: 细菌耐药问题已成为全球危机,为遏制细菌耐药,我国不少专家和学者都开展了对细菌耐药的研究,这些研究大多是从微观的角度、从细菌耐药本身开展的探索,从宏观角度研究的很少。本研究旨在从宏观管理的角度,用流行病学的思路和方法,研究我国细菌耐药性在时间、空间、抗菌药间的“三间”分布情况,为细菌耐药研究者提供新的研究思路,促进细菌耐药研究的全面性,并预测细菌耐药性的发展趋势,探索潜在的用药风险;通过利益集团分析方法,分析我国控制细菌耐药性策略的可行性,最终提出优先控制策略,以达到提高我国控制细菌耐药性、提高抗菌药的效果、节约有限卫生资源的目的。方法: 本研究综合采用文献法、访谈法、非接触性研究方法、统计学方法、聚类分析方法和利益集团分析方法等多种方法进行研究,搜集的资料包括:(1)国内外细菌耐药研究的文献资料;(2)国家细菌耐药监测网2001~2005年三级甲等医院的耐药监测资料;(3)国家细菌耐药监测网北京、天津、广东、广西、辽宁、四川、湖北、浙江8省(市)2001~2005年大肠埃希菌对常见抗菌药的耐药数据。结果与结论: 1、通过对细菌耐药性的理论研究,发现细菌耐药性的产生和蔓延除了受细菌和药物自身的特点影响外,人类的活动也能改变细菌耐药性发展的速度;有关细菌耐药控制的政策包括推行国家基本药物政策、合理用药政策、药品分类管理等;我国细菌耐药监测工作存在覆盖面不广、监测力度不够、缺乏交流与协作、监测结果对临床反馈不够、耐药监测与临床用药存在脱节等问题。 2、通过比较国家细菌耐药性监测网2001~2005年三级医院的监测数据,发现G-杆菌占主要地位,尤以大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌等条件致病菌最为常见。横向来看,各年临床分离菌种的排序位置变动不大。 3、以大肠埃希菌作为研究对象,进行细菌耐药性的“三间”分布研究:(1)时间分布:2001～2005年大肠埃希菌对临床常用抗菌药的耐药率不同,耐药率整体上呈上升趋势,尤其是头孢噻肟、头孢他啶、头孢呋辛钠等,平均每年增加20个百分点;对细菌耐药率发展速度大于1的抗菌药进行预测,发现2010年时,头孢噻肟、头孢唑林、氨苄西林、头孢呋辛钠、萘啶酸、左氧氟沙星等的耐药率将达到100%。(2)空间分布:细菌耐药性呈现一定的地区差异,北京、广西与四川较为接近,耐药情况较好,广东、辽宁与天津较为接近,浙江情况最为严重;沿海城市耐药率与内陆城市耐药情况不同,大肠埃希菌对亚胺培南、头孢他啶、环丙沙星、氨曲南的耐药率都是沿海地区高于内陆地区且差异有统计学意义,哌拉西林是内陆地区高于沿海地区且差异有统计学意义,头孢噻肟差异无统计学意义。(3)抗菌药间分布:细菌在抗菌药间的分布不同,青霉素类、磺胺类、四环素类和喹诺酮类耐药情况最为严重,单环β-内酰胺类、碳青霉烯类等耐药率比较低。 4、对细菌耐药控制策略进行相对稳定利益集团分析,发现应加强开发、协调政府、卫生行政部门和药品监管部门等利益集团,加强对医疗机构位的规范和管理,加强农业部门、医务人员和有关企业的监管,加强对耐药监测机构和患者的宣传、教育。对该策略进行相对变动利益集团分析,对于政府应加强维持、提高其作用,农业部门、医疗机构、医务人员、有关企业应加强管理和管制,卫生行政部门、药监部门、耐药监测机构和患者应加强协作和教育。策略的16条措施中,优先措施包括:以微生物学检验结果为依据选用抗菌药、组建或确定国家级细菌耐药性监测中心、建立和开展快速的病原学诊断方法、为鼓励开发新的药物与疫苗等。 5、指出研究者在考察细菌对抗菌素的耐药性或敏感性时,发现应该注意研究的年代、国家或地区、抗菌药的种类和使用情况,这样比较的结果才有实际意义。 6、有关细菌耐药水平与抗菌药的使用量之间的宏观量化关系、细菌耐药水平与抗菌药不合理使用之间的因果关联,需要进一步研究。建议: 1、政府应对细菌耐药问题给予足够的重视,真正承担起遏制细菌耐药的责任。具体包括:(1)建立健全法律法规,进一步加强药品合理使用和监督管理;(2)继续深化医疗卫生体制改革;(3)尽快建立一个由国家行政管理机构领导的、统一的、权威的、信息资源共享的细菌耐药性监测系统,由国家投入经费,对全国监测机构、医院进行组织协调;(4)加强对有关行政部门的引导和协调作用。(5)采取措施鼓励疫苗和新抗菌药的开发。 2、医疗机构和医生切实履行合理使用抗菌药。具体包括:(1)医院制订临床抗菌药物应用的指南和处方集;(2)建立药事管理委员会,加强医院内的管理措施,建立抗菌药临床合理应用保障体系;(3)加强细菌耐药监测对临床抗菌药使用的反馈,用细菌耐药监测结果指导抗菌药的使用;(4)提高病原菌诊断水平,根据药敏实验结果选择抗菌药物;(5)医生应肩负治疗患者的医学责任和尽可能维持细菌对抗菌药敏感性的社会责任。 3、加强教育和宣传,提高社会各阶层对细菌耐药问题和合理用药的认知率。本论文的创新点和下一步需要进行的研究: 创新点:1.本论文首次从宏观管理的角度,用流行病学的思路和方法,研究了细菌耐药性在时间、空间、抗菌药间的“三间”分布情况。提出研究者在考察细菌耐药性时,应注意研究的时间、地区、抗菌药的种类和使用情况。2.通过利益集团分析方法,分析我国控制细菌耐药性策略的可行性,提出优先控制策略。提出应对细菌耐药这个全球危机不仅要从在微观上进一步研究细菌耐药机制和研制新的抗药药物,更重要的是,在宏观上加强对抗菌药使用的管理和控制,其中政府应承担主要责任,具体措施落实在医疗机构和医生。下一步需要进行的研究:有关细菌耐药水平与抗菌药的使用量之间的宏观量化关系、细菌耐药水平与抗菌药不合理使用之间的因果关联。
[Abstract]:Purpose :

Bacterial resistance has become a global crisis . In order to contain the drug resistance of bacteria , many experts and scholars in our country have carried out the research on the resistance of bacteria . Most of these studies have been carried out from the viewpoint of macro - management . The study aims to study the " three - compartment " distribution of bacterial drug resistance in our country from the perspective of macro - management .

Method :

This paper studied the methods of literature , interview , non - contact , statistics , cluster analysis and interest group analysis . The data collected include : ( 1 ) the literature data of the research on the drug resistance at home and abroad ; ( 2 ) the data of resistance monitoring of the third class A - class hospital in 2001 - 2005 ; ( 3 ) the resistance data of the large intestine Escherichia coli to the common antibiotics in Beijing , Tianjin , Guangdong , Guangxi , Liaoning , Sichuan , Hubei and Zhejiang provinces ( cities ) from 2001 to 2005 .

Results and Conclusions :

1 . Through the theoretical research on the drug resistance of bacteria , it is found that the generation and spread of drug resistance of bacteria can change the speed of drug resistance development in addition to the characteristics of bacteria and drugs . The policies related to drug resistance control include the introduction of national basic drug policy , rational drug administration policy , drug classification management , etc .

2 . By comparing the monitoring data of the national bacterial drug resistance monitoring network from 2001 to 2005 , it was found that the dominant status of G - bacilli , especially in Escherichia coli , Pseudomonas aeruginosa and Klebsiella pneumoniae , was the most common .

3 . The drug resistance rate of E . coli was 100 % . The drug resistance rate of E . coli was 100 % . The drug resistance rate of E . coli was higher than that of inland cities .

4 . To analyze the drug resistance control strategy with a relatively stable interest group . It is found that the development and coordination of interest groups such as the government , the health administration department and the drug regulatory authorities should be strengthened to strengthen the regulation and management of the medical institutions , strengthen the supervision and education of the drug - resistant monitoring institutions and patients , strengthen the management and control of the drug - resistant monitoring bodies and patients , strengthen the management and control of the drug - resistant monitoring bodies and patients , and strengthen cooperation and education . Among the 16 measures of the strategy , the priority measures include the selection of anti - bacterial drugs according to the results of microbiological testing , the establishment or determination of the national - level bacterial drug resistance monitoring centers , the establishment and implementation of rapid pathogenic diagnostic methods , and the development of new drugs and vaccines .

5 . It is pointed out that when investigating the drug resistance or sensitivity of the bacteria to antibiotics , it is found that the study ' s age , country or region , the type and use of the antibacterial drugs should be paid attention to , so that the results of the comparison are practical .

6 . The macro - quantitative relationship between the drug resistance level and the usage amount of the antimicrobial agent , the causal association between the bacterial resistance level and the unreasonable use of the antimicrobial agent , need further study .

Recommendation :

1 . The government should pay enough attention to the problem of bacterial resistance , and truly bear the responsibility to contain the drug resistance of bacteria .

( 3 ) To strengthen the management measures in hospitals , strengthen the management measures in the hospital , establish the clinical rational application guarantee system of the antibacterial drugs , ( 3 ) strengthen the use of the antibiotics to monitor the use of the antibacterial drugs , ( 4 ) improve the diagnostic level of the pathogens , and ( 5 ) the doctor should shoulder the medical responsibility for the treatment of the patient and maintain the social responsibility of the bacteria to the sensitivity of the antibacterial drugs as much as possible .

3 . Strengthen education and publicity , and raise awareness of the drug resistance and rational drug use at all levels of society .

The innovation points and the next step of this thesis need to be studied :

Innovation point : 1 . The paper first studied the distribution of bacteria drug resistance in time , space and anti - bacterial medicine from the perspective of macro - management .

In this paper , we should pay attention to the research time , region , and the types and use of the antimicrobial drugs .

The next step is to investigate the macroscopic quantitative relationship between the level of bacterial resistance and the usage of the antimicrobial agent , the causal association between the level of bacterial resistance and the irrational use of the antimicrobial agent .

【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R378

【引证文献】