我院2011年主要病原菌耐药率及抗菌药物使用量分析

Analysis of the main pathogenic bacteria resistance rates and antibacterial drugs usage in our hospital in 2011

目的分析我院主要病原菌耐药率与抗菌药物的使用情况,为临床合理使用和管理抗菌药物提供参考。方法采用SPSS13.0软件对我院2011年检出的阳性菌及其药敏实验结果进行统计分析,结合全年抗菌药物使用频度(DDDs)分析抗菌药物使用的合理性。结果共检出阳性标本5 822例,其中革兰阳性菌1 927株,占33.1%。分离的革兰阳性菌中,金黄色葡萄球菌占首位(16.9%),其次是溶血性葡萄球菌(15.9%)和表皮葡萄球菌(14.1%)。耐甲氧西林金黄色葡萄球菌(MRSA)占36.7%,耐甲氧西林凝固酶阴性葡萄球菌(MRS-coN)占82.5%,对所有的β-内酰胺类抗生素均耐药,对万古霉素、夫西地酸和替考拉宁的敏感性较好,耐药率均未超过6.47%;革兰阴性菌2 661株,占45.7%,分离的革兰阴性菌主要以肠杆菌科细菌和非发酵菌为主,肠杆菌科中以大肠埃希菌(23.5%)、肺炎克雷伯菌(15.6%)和阴沟肠杆菌(3.7%)为主,肠杆菌科细菌对含酶抑制剂的哌拉西林/他唑巴坦、头孢哌酮/舒巴坦均保持较好的敏感性,耐药率低于27.82%,对阿米卡星的耐药率低于14.36%;非发酵菌以铜绿假单胞菌(10.2%)、醋酸钙鲍曼不动杆菌(7.9%)和嗜麦芽窄食单胞菌为主。非发酵菌对头孢哌酮/舒巴坦的敏感性较好,耐药率未超过29.44%;对喹诺酮类药物的耐药率超过31.39%;三、四代头孢对非发酵菌耐药率均超过35.19%;亚胺培南对鲍曼不动杆菌的耐药率达到81.32%。大多数细菌的耐药率与抗菌药物使用强度呈正相关(r>0.3,P<0.05)。结论我院细菌耐药情况严重,应加强抗菌药物使用管理,尽早明确病原菌,并根据药敏试验结果选用抗菌药物,减少耐药性的发生。

Objective To analyze the main pathogenic bacteria resistance rates and antibacterial drugs usage in our hospital, and provide reference for the rational of antimicrobial drugs and management. Methods The SPSS13.0 software was used for statistical analysis of pathogenic bacteria drug resistance from the detected positive bacteria and its susceptibility test results in my hospital in 2011, combined with the annual antibiotics DDDs to analyze the rationality of antibacterial drug use. Results Among the positive samples were Gram-positive bacteria of 1927,accounting for 33.1% of the 5 822 cases. Separation of Gram-positive bacteria,Staphylococcus aureus accounted for in the first place （16.9%）, followed by hemolytic Staphylococcus aureus（ 15.9% ） and Staphylococcus epidermidis（ 14.1% ）. Methicillin-resistant Staphylococcus aureus （ MRSA ） （ 36.7% ） , methieillin-resistant coagulase-negative staphylococci（MRS-con） accounted for 82.5% , were resistant to all beta-lactam antibiotics, vancomyein, fusidic acid and teicoplanin better sensitivity, resistance rates did not exceed 6.47% ;Gram-negative bacteria of 2 661 , accounting for 45.7% , the separation of Gram-negative bacteria Enterohacteriaeeae and non-fermenting bacteria, Eseherichia coli, Enterobacteriaceae （ 23.5% ） , Klebsiella pneumoniae （15.6%）and Enterobacter cloacae（3.7% ） ,Enterobacteriaceae inhibitor-containing piperacillin/tazobaetam,cefoperazone/sulbactam are kept better sensitivity, resistance rates lower than 27.82% , amikacin rate of less than 14.36% ; non-fermenting bacteria Pseudo- monas aeruginosa（ 10.2% ）, calcium acetate Bowman Aeinetobacter（7.9% ）and Stenotrophomonas narrow mainly food Aeromonas. Non-fermenting bacteria to cefoperazone/sulbactam better sensitivity,resistance rates did not exceed 29.44% ;Resistance to quinolones rate of more than 31.39% ;third and fourth generation cephalosporin resistance rates of non-fermenting bacteria more than 35.19% ; imipenem resistant Acinetobacter baumannii rate of 81.32%. The most bacterial resistance rates with the use of antibiotics strength was positively correlated （ r 〉 0.3 ,P 〈 0.05 ）. Conclusion Bacterial drug resistance situation was more serious in my hospital. The use and management of antibiotics should be strengthened as soon as possible, and drugs should be selected according to clear pathogens and antimicrobial susceptibility test to reduce drug resistant bacteria produce.