2005-2006年抗生素应用与细菌耐药监测状况分析

Survey on the antibiotic use and antibiotic resistance during 2005 to 2006

目的了解本地区儿科抗生素的使用情况和细菌耐药性的流行趋势。方法从医院HIS服务器中提取重庆医科大学附属儿童医院2005年1月-2006年12月所有来院就诊患儿消耗药品的详情,采用限定日剂量(DDD)法分析抗生素的使用趋势;根据儿童感染性疾病的诊断、治疗标准,制定统一的病例报告表(casereportform,CRF),以病案室提取的住院病历为依据填写呼吸、感染和PICU病房的CRF表,以此反应患儿的基本情况和抗生素的使用状况;同期临床分离病原细菌采用Kirby!Bauer法进行药敏检测,按美国临床实验标准委员会2005版标准分析结果,对金黄色葡萄球菌等8种临床常见致病菌耐药性监测的2年资料进行统计分析。结果2年中抗生素消耗金额分别占同期药品的51.88%、48.17%,抗生素累积DDDs分别占同期药品的11.53%、11.95%,2年中平均有63.29%门诊内科患儿使用抗生素,住院病区人均用抗生素品种最高为3.14个;2年分离8种病原菌5767株,其中革兰阴性菌占60.20%,主要分离菌为大肠埃希菌(25.30%)、肺炎克雷伯杆菌(23.25%)、铜绿假单胞菌(7.82%)、流感嗜血杆菌(3.83%),肠杆菌科病原菌的产ESBL酶的分离率在50%以上,亚胺培南、头孢吡肟和环丙沙星对肠杆菌科细菌的抗菌活性最强I革兰阳性菌占39.80%%,主要为肺炎链球菌(21.00%),青霉素不敏感率2年分别为63.18%和70.45%;金黄色葡萄球菌检测率为16.79%,青霉素不敏感率2年分别为93.54%和95.89%。结论2年中抗生素的消耗保持较高水平,ESBL仍然是目前革兰阴性菌中的主要问题,未发现万古霉素耐药肠球菌,对临床分离株的耐药情况应进行流行病学调查及采取相应的控制措施。

Objectives To investigate the pattern of antibiotic use and antibiotic resistance tendency in a tertiary children＇s hospital. Methods Detailed antibiotic utilization in hospitalized patients was retrospectively reviewed using the hospital medical records from Jan. 2005 to Dec. 2006. The use of antibiotics .was expressed in defined daily dose （DDD）. The case report form （CRF） was created based on the standard of diagnosis and treatment of infectious diseases. From the medical history of patients the CRF forms were filled out in selected patients with respiratory diseases or infectious diseases, and patients in pediatric intensive care unit. So the basic information of patients and pattern of antibiotics use were obtained. Meanwhile, the bacteria were isolated and identified, and the susceptibility was tested by using Kirby-Bauer. The results were interpreted in accordance with NCCLS 2005 year guideline. Eight species of most often isolated bacteria, such as Staphylocccus anreus, and their antibiotic resistance tendency in two years were evaluated. Results The proportions of the cost of antibiotics in all drugs were 51,88% in 2005 and 48,17% in 2006 respectively. The percentages of DDDs of antibiotics in all drugs＇ were 11.53% in 2005 and 11.95% in 2006 respectively, Antibiotics were used in 63,29% patient during two years. On average hospitalized patients were given 3.14 different antibiotics. Eight species of 5767 strains of bacteria were isolated 60.20% bacteria were gram negative most of them were Enterobacteria （25.30%）, Klebsiellar pneurnoniae （23.25%）, P, aeruginosa （7.82%） and Haemophilus influenzae（3,83%）. The separation of extended spectrum B-lactamase （ESBL） were seen in more than 50% bacillus bacterium. Imipenem, Cefepime and Ciprofloxacin were the most potant antibacterial for bacillus bacterium, 39.80% bacteria were gram positive most of them were pneumococcus （21.00%） and Staphylocccus aureus （16.79%）. The percentages of pneumococcus resistant to penicillin were 63.18% in 2005 and 63.45% in 2006. The percentages of Staphylocccus aureus resistent to penicillin were 93.54% in 2005 and 95.89% in 2006. Conclusions The total expenditure of antibiotics remains at a high level. The extended spectrum B-lactamase （ESBL） is still the major problem in gram negative germ. Vancomyein-resistant Enterococcus has not been discovered. It is urgent to conduct epidemiological investigation and to take appropriate measures in control of bacterial resistance.