2012—2014年首都医科大学昌平教学医院抗菌药物使用与细菌耐药性分析

Application of Antibiotics and Analysis of Bacterial Resistance in Beijing Changping Hospital of Capital Medical University during 2012-2014

目的:了解近3年首都医科大学昌平教学医院(以下简称"我院")抗菌药物使用情况及病原菌耐药性变化,分析抗菌药物用量与细菌耐药性变迁间的相关性,指导临床合理用药。方法:采用收集、统计、对比分析方法,对我院2012—2014年住院患者各类标本培养分离出的病原菌分布、耐药情况和常用抗菌药物用药频度(defined daily dose system,DDDs)、用药强度进行回顾性分析。结果:3年分离出非重复病原菌3 526株,其中革兰阴性杆菌占62.2%,革兰阳性球菌占27.8%,真菌占10.0%;分离率位于前5位的病原菌分别是大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌;抗菌药物DDDs排名前5位集中在头孢菌素、头霉素、左氧氟沙星,其中第3代头孢菌素DDDs连续3年居第1位,2013年DDDs排名前5位抗菌药物中有3种DDDs增长,2014年新增品种头孢噻肟位居第1位,其他4种头孢DDDs均下降,特殊级抗菌药物美罗培南DDDs增长迅速;2013年耐药率有所下降,2014年肺炎克雷伯菌和鲍曼不动杆菌耐药率上升,且鲍曼不动杆菌耐药率增长迅速。结论:我院3年住院抗菌药物监控指标均达标,部分病原菌耐药性呈持续下降趋势,但随着第3代头孢菌素和左氧氟沙星的大量使用,我院细菌耐药形式依然严峻,需加强临床抗菌药物的使用管理和细菌耐药性监测。

OBJECTIVE： To investigate the application status of antibiotics and changes of bacterial resistance in Beijing Changping Hospital of Capital Medical University（ hereinafter referred to as ＂our hospital ＂） in recent three years,and to probe into the correlation between the application amount of antibiotics and changes of bacterial resistance,so as to provide guidance for the rational drug use in clinic. METHODS： Collecting,statistical and comparative analysis was adopted to conducted retrospective analysis on the distribution of pathogenic bacteria,drug resistance,defined daily dose system（ DDDs） of commonly used antibiotics and AUD isolated from cultured specimens of inpatients in our hospital during 2012-2014. RESULTS： 3 526 non repetitive pathogens were isolated during three years,among which gram negative bacilli accounted for 62. 2%,gram positive cocci accounted for 27. 8% and fungi accounted for 10. 0%; the isolation rate of pathogen in the top five strains were escherichia coli,klebsiella pneumoniae,staphylococcus aureus,pseudomonas aeruginosa and acinetobacter bauman coli. The top five antibiotics ranked by DDDs were cephalosporins,cephamycins,levofloxacin,among which DDDs of the third generation cephalosporin ranked first in three consecutive years; of the top five DDDs,3 kinds of antibiotics were in DDDs growth in 2013,new varieties of cefotaxime dominated the first place in2014,DDDs of another four kinds decreased,but DDDs of the special class of antibiotics of meropenem increased rapidly. The drug resistance rate slightly decreased in 2013,while the resistance rate of klebsiella pneumoniae and bauman acinetobacter increased in 2014,and bauman acinetobacter were in a rapid growth. CONCLUSIONS： The monitoring indicators of antibiotics for inpatients are up to standard during the three years in our hospital,the resistance of some pathogenic bacteria are in a decline tendency. With the large consumption of the third generation cephalosporins and levofloxacin,the current situation of bacterial resistance remains severe which needs to strengthen the application ofclinical antibiotics and monitoring of bacterial resistance.