临床药师根据细菌耐药性参与临床合理使用抗菌药物

Reasonable clinical use of antibiotics based on bacterial resistance

目的了解医院临床培养分离出的病原菌分布及耐药性，为合理使用抗菌药物提供依据。方法抽取医院2010—2012年每年的7—12月份医院住院患者临床分离的病原菌及耐药性结果进行调查并加以分析，采用美国德灵公司walk Away 240 进行细菌鉴定及药敏试验，药敏结果依据美国临床实验室标准化委员会（NCCLS）标准判定。结果近3年医院排名前5位的革兰阴性菌依次为大肠埃希菌占18．0％～33．0％、铜绿假单胞菌占14．0％～19．0％、肺炎克雷伯菌占14．0％～17．0％、鲍氏不动杆菌占10．0％～21．0％和嗜麦芽寡养单胞菌占3．0％～6．0％；革兰阳性菌以凝固酶阴性葡萄球菌及金黄色葡萄球菌为主；2012年7—12月分离出的病原菌耐药率明显下降。结论临床药师参与临床合理选用抗菌药物，减少了新的耐药菌株出现。

OBJECTIVE To understand the distribution and drug resistance of the clinical isolates of pathogens so as to provide guidance for reasonable clinical use of antibiotics. METHODS From Jul to Dec in each year of 2010-2012, the distribution and drug resistance of the pathogens isolated from the hospitalized patients were investigated and analyzed, then the bacterial identification and drug susceptibility testing were performed with the use of Walk A-way 240 of Dade Behring, the United States, and the result of the drug susceptibility testing was determined based on the criteria of national committee for clinical laboratory standards（NCCLS）. RESULTS In the past three years, the Escherichia coli （ 18. 0%-33.0%）, Pseudomonas aeruginosa （ 14.0%-19.0%）, Klebslella pneumoniae （14.0%-17.0%）, Acinetobacter baumannil （10.0%-21.0%）, and Stenotrophomonas maltophilia （3.0%-6.0%） ranked the top five species of gram-negative bacteria. The coagulase-negative Staphylococcus and Staphylococcus aureus were the predominant species of gram-positive bacteria. The drug resistance rates of the pathogens isolated from Jul 2012 to Dec 2012 were significantly decreased. CONCLUSION The clinical pharmacists′ participation to the reasonable clinical use of antibiotics may contribute to the reduction of novel species of drug-resistant strains.