抗菌药物临床干预对常见医院感染病原菌耐药的影响

Clinical intervention effect of antibacterials on antibiotic resistance of nosocomial infection pathogens

目的探讨抗菌药物的临床干预措施对医院常见医院感染病原菌耐药的影响。方法将2007-2008年发生医院感染的患者作为对照组,2009-2010年医院感染患者作为干预组;应用SPSS 11.0统计软件,比较干预前后两组的抗菌药物使用量、抗菌药物使用率以及细菌耐药率的变化。结果干预后,部分三线药物头孢他啶、头孢哌酮/舒巴坦以及头孢吡肟等使用量明显下降,与对照组相比,干预组的抗菌药物使用率为50.7%、联合用药率为35.2%、手术预防使用率为59.7%,较前均明显下降,差异有统计学意义(P<0.05);干预组铜绿假单胞菌对亚胺培南的耐药率为25.5%,对头孢吡肟的耐药率为14.7%,鲍氏不动杆菌对头孢吡肟的耐药率为35.2%,对哌拉西林/他唑巴坦的耐药率为24.7%,肺炎克雷伯菌对头孢哌酮/舒巴坦的耐药率为33.6%,大肠埃希菌对头孢哌酮/舒巴坦的耐药率为24.2%,对哌拉西林/他唑巴坦的耐药率23.2%,以上耐药率与对照组相比均明显下降,差异有统计学意义(P<0.05);耐甲氧西林金黄色葡萄球菌(MRSA)对抗菌药物的耐药率高于甲氧西林敏感金黄色葡萄球菌(MSSA),经过干预后,MSSA对亚胺培南、左氧氟沙星耐药率明显下降,耐药率分别为12.0%、20.0%,差异有统计学意义(P<0.05)。结论对医院抗菌药物使用进行有效的管理和监测,严格掌握用药原则,对减少耐药菌株的产生有重要意义。

OBJECTIVE To examine the effect of clinical intervention of antibacterials on antibiotic resistance of nosocomial infection pathogens. METHODS Medical records were collected between 2007 and 2010,and classified into two groups：control group, the nosocomial infection patients between 2007 and 2008 ; and intervention group including the nosocomial infection patients between 2009 and 2010. The dosage and usage of antibiotics and the drug resistence rate were analyzed by SPSS11. 0 Software. RESULTS The dosage of antibiotics （ceftazidime, cefoperazone/SBT, cefepime, et al. ） was remarkably depressed in intervention group than in control group. The usage （50.7%）, combination ratio （35.2%） and precautionary ratio of antibiotics （59.7 %） in intervention group were significantly decreased compared with control group （P〈0.05）. The ratio of drug resistance to imipenem （25.5%） and cefepime （14.7%） in Pseudomonas aeruginosa, cefepime （35.2%） and Piperacillin/TAZ （24.7%） in Acinetobacter baumanii, cefoperazone/SBT （33.60%） in Klebsiella pneumoniae, cefoperazone/SBT （24.2%） and piperacillin/TAZ （23.20%） in Bacillus coli, and the ratio of drug resistance to the four bacteriums above were notably decreased in intervention group than in control group. The ratios of drug resistance of MRSA were higher than that of MSSA. The ratio of drug resistance of MSSA to imipenem （12.0 %） and levofloxacin （20.0%） were significantly decreased in intervention group than that in control group （P〈0. 05）. CONCLUSION To enhance surveillance of antibacterial use and improve the reasonable application of antibiotics is propitious to control the occurrence of nosocomial infections.