专项整治活动对我院抗菌药物合理应用和减缓细菌耐药性的效果评价

发布时间：2018-07-18 20:32

【摘要】：目的:评价抗菌药物临床应用专项整治活动对我院抗菌药物合理应用及减缓细菌耐药性的效果。方法:按抗菌药物专项整治前后3年进行分组,比较两组抗菌药物临床应用相关指标及细菌耐药性等数据。结果:专项整治后,住院患者抗菌药物使用率从77%降至55%,抗菌药物使用强度从86 DDDs/(100人·d)降至39 DDDs/(100人·d),Ⅰ类切口手术患者预防使用抗菌药物比例从98%降至27%,门、急诊患者抗菌药物处方比例分别从36%、49%降至12%、23%。微生物检验标本送检率从20.2%升至38.8%,无菌部位标本送检率从29.8%升至37.6%。真菌检出率从14.4%降至11.2%。大肠埃希菌、肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)菌株的检出率分别从57.3%、43.2%降至51.3%、36.1%。居前5位细菌的多重耐药菌总检出率从48.4%降至29.3%,但2014年多重耐药鲍曼不动杆菌检出率升至80.7%,鲍曼不动杆菌对亚胺培南、美罗培南的耐药率分别达到66.9%、69.1%。肺炎克雷伯菌对第一、二、三代头孢菌素类、哌啦西林/他唑巴坦、亚胺培南、美洛培南的耐药性有增加趋势。结论:抗菌药物专项整治活动效果明显,提高了医院抗菌药物临床应用的管理水平,但细菌耐药形势仍然严峻,需要建立抗菌药物临床应用长效管理机制,加强病原学检查和细菌耐药性监测,严格执行手卫生和消毒隔离制度。
[Abstract]:Objective: to evaluate the effect of clinical treatment of antimicrobial agents on rational use of antimicrobial agents in our hospital. Methods: according to the three years before and after the special treatment of antimicrobial agents, the clinical application indexes and bacterial resistance data of the two groups were compared. Results: after special treatment, the utilization rate of antibiotics in inpatients decreased from 77% to 555.The intensity of antimicrobial use decreased from 86 DDDs / (100 days) to 39 DDDs / (100 patients with d), I incision operation) from 98% to 27%. The proportion of antimicrobial prescriptions in emergency patients decreased from 36% to 122323%, respectively. The rate of microbiological examination was increased from 20.2% to 38.8%, and that of aseptic site from 29.8% to 37.6%. The detection rate of fungi decreased from 14. 4% to 11. 2%. The detection rate of extended-spectrum 尾 -lactamases (ESBLs) produced by Escherichia coli and Klebsiella pneumoniae decreased from 43.2% to 51.3% to 36.1% respectively. The total detection rate of multidrug resistant bacteria in the top 5 bacteria decreased from 48.4% to 29.3%, but the detection rate of Acinetobacter baumannii increased to 80.7 in 2014. The resistant rates of Acinetobacter baumannii to imipenem and meropenem reached 66.9% and 69.1% respectively. The resistance of Klebsiella pneumoniae to the first, second and third generations of cephalosporins, piperacillin / tazobactam, imipenem, and meropenem increased. Conclusion: the effect of special antimicrobial treatment activities is obvious and the management level of clinical application of antimicrobial drugs in hospitals is improved. However, the situation of bacterial drug resistance is still severe, so it is necessary to establish a long-term management mechanism for the clinical application of antimicrobial agents. Strengthen pathogenic examination and bacterial resistance surveillance, strictly implement hand hygiene and disinfection isolation system.
【作者单位】：重庆市急救医疗中心;
【分类号】：R95

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