医院感染病原菌耐药性与抗菌药物使用频度分析

Analysis of bacterial resistance of hospital infections and usage frequency of antibiotic drugs

目的调查医院感染病原菌耐药性与临床抗菌药物使用频度,分析两者的相关性,提高医院抗菌药物合理使用水平。方法采用回顾性方法,对医院2008-2013年住院患者标本送检率、病原菌耐药率及抗菌药物使用频度进行统计,依据抗菌药物对细菌作用原理进行分析。结果 DDDs排名前5位的抗菌药物依次是头孢菌素类、氟喹诺酮类、硝基咪唑类、β-内酰胺酶抑制类和青霉素类;检出前3位病原菌依次为大肠埃希菌、金黄色葡萄球菌和产酸克雷伯菌,检出率分别为39.8%、21.9%和13.5%;大肠埃希菌耐药率与头孢菌素类DDDs在连续增长阶段呈强相关,产酸克雷伯菌耐药率与氨基糖苷类DDDs呈弱相关,金黄色葡糖球菌耐药率与青霉素类DDDs呈强相关,与氟喹诺酮类DDDs有明显相关性。结论临床医师应根据微生物药敏试验结果合理选用抗菌药物,增加目标用药以及通过降低用药起点,科学、安全、有效的选择抗菌药物,以降低医院病原菌耐药率。

OBJECTIVE To investigate the bacterial resistance and the DDDs of antibiotic drugs in the hospital and the analyze the correlation between them ,so as to improve the level of rational use of antibiotic drugs .METHODS A retrospective method was used to summarize the delivery rate of microbial samples for inspection , drug resistance of pathogens ,and the DDDs of antibiotic drugs .And the mechanism of action of antibiotic drugs on bacteria was referred for analysis .RESULTS The antibiotic drugs of top five DDDs in order were cephalosporins , fluoroquinolones ,nitroimidazoles ,β‐lactamase inhibitors and penicillins .The pathogens ranking the first three in order were Escherichiacoli ,Staphylococcus aureus and Klebsiellaoxytoca,accounting for 39 .8% ,21 .9% and 13 .5% respectively .There was a strong correlation between E .coli resistance and the DDDs of cephalosporins in the continuously increasing stage . There was a weak correlation between K . oxytoca and the DDDs of aminoglycosides .S . aureus resistance had a strong correlation with the DDDs of penicillins and a significant correlation with the DDDs of fluoroquinolones .CONCLUSION Clinicians should rationally choose antibiotics according to results of microorganism inspection test ,increasing the target drugs as well as lowering the starting point of medication ,scientifically choose safe and effective antibiotic drugs so as to reduce the pathogen resistance in the hospital .