大环内酯类与氟喹诺酮类药物临床应用现状分析

Present Situation Analysis of Clinical Application of Macrolides and Quinolones

目的了解引起呼吸系和泌尿系感染病原菌分布及耐药情况,为临床合理用药提供依据。方法调查引起呼吸系和泌尿系感染的病原菌分离率以及对大环内酯类和氟喹诺酮类药物的耐药性。根据院内抗菌药物使用量和销售额进行分析。结果呼吸系和泌尿系感染中以大肠埃希菌检出率最高,分别占检出菌总数的18.6%和42.1%,呼吸系其他分离率较高的病原菌是凝固酶阴性葡萄球菌、铜绿假单胞菌、克雷伯菌属;泌尿系其他分离率较高的病原菌是真菌、肺炎克雷伯菌、铜绿假单胞菌。大肠艾希菌对环丙沙星等四种氟喹诺酮类药的耐药率在57.5%以上,高于铜绿假单胞菌和克雷伯菌属的耐药率;葡萄球菌对红霉素等的耐药率较高,对左氧氟沙星的耐药率较低。氟喹诺酮类药物销售金额占第三位,使用强度为22.38;大环内酯类药物销售金额占第五位,使用强度为5.51。结论临床可根据药敏结果选择抗感染药物,同时也应分析药物成本和疗效关系选用抗感染药物。

Objective To understand the distribution and drug resistance situation of pathogens which caused infections of respiratory and urinary systems, and to provide scientific basis for clinical ra- tional use of antimicrobial drugs. Methods We investigated the distribution and drug resistance of pathogens to Macrolides and Quinolones of some hospitals. We can calculate the pathogen separation rate and the resistance rate to antimicrobial drugs through the analysis of these data. Finally, these data were analyzed according to the cost - efficacy analysis method. Results The detection rate of E. coli was highest on respiratory and urinary systems and their rates were 18.6% and 42.1% on the total number of bacteria detection respectively. On respiratory, the other higher detection pathogenic bacteria were coagu- lase negative staphylococcus, pseudomonas aeruginosa, klebsiella bacteria genera. On urinary tract, the other higher detection pathogenic bacteria were fungi, klebsiella pneumoniae, pseudomonas aeruginosa. The resistant rate （ 〉 57.5% ） of E. coli was higher than that of pseudomonas aeruginosa and klebsiella bacteria on four fluoroquinolone drugs （ciprofloxacin etc）. The resistant rate of staphylococcus was higher on erythromycin and was lower on levofloxacin. Fluoroquinolone drugs was third on drugs sales amount, the antibiotics use density （AUD） was 22.38. Macrolides drugs was fifth on drugs sales amount, the an- tibiotics use density （AUD） was 5.51. Conclusion The antimicrobial drugs should be chosen consider- ing the results of drug sensitivity with drug costs and curative effect