2010—2011年我院抗菌药物使用量与细菌耐药分析

Consumption of antibiotics and bacterial resistance in a hospital of Shanghai during 2010—2011

目的分析上海市某医院抗菌药物使用量及临床分离菌对常用抗菌药物的耐药性情况,为临床合理用药提供参考。方法统计和分析2010-2011年间医院住院患者抗菌药物使用强度(DDDs)及主要临床分离菌对常用抗菌药物的耐药性。结果 2年间临床选择以头孢霉素类、喹诺酮类、含β-内酰胺酶抑制剂类等抗菌药物为主,DDDs变化大的有头孢呋辛钠、左氧氟沙星、氨苄西林钠—舒巴坦钠等常用药物(DDDs降幅>30%)。2011年大肠埃希杆菌和肺炎克雷伯菌对头孢呋辛钠耐药率下降明显(P<0.05),大肠埃希杆菌、鲍曼不动杆菌和金黄色葡萄球菌对左氧氟沙星耐药率下降也十分明显(P<0.01)。其他临床常见菌对常用抗菌药物耐药率有超过50%的品种呈下降趋势。结论抗菌药物DDDs与细菌耐药性有一定相关性。医院应积极开展细菌耐药性监测,调整药物品种结构,促进临床合理用药,有利于减少细菌耐药性的产生。

Objective To investigate the consumption of antibiotics and the drug resistance of the bacteria isolated from clinical samples for rational use of antibacterials in Shidong Hospital in Yangpu district of Shanghai. Methods The DDDs of inpatients and the drug re- sistance of the bacteria isolated from clinical samples in 2010--2011 were analyzed. Results In the 2 years from 2010 to 2011, the main clinical selection was cephalosporins, quinolones and β-lactamase inhibitors. The drugs of great variation of DDDs included cefuroxime, levofloxacin, Ampicillin Sodium and Sulbaetam Sodium（ the amplitude reduction of DDDs 〉 30% ）. In 2011 the resistance rates of Esche- richia coli and Klebsiella pneumoniae to cefuroxime declined obviously（ P 〈 0.05 ）. The resistance rates of Escherichia coli and Acineto- baeter baumannii and Staphylococcus aureus to levofloxaein decreased significantly （ P 〈 0.01 ）. And the drug resistance rates of other clinical samples showed a downward trend more than 50% in the same year. Conclusions There was a positive correlation between the DDDs and bacterial resistance. Active surveillance of bacterial resistance in hospital, adjustment of drug variety structure, guidance of clinical rational drug use should be carried out to reduce bacterial resistance.