我院呼吸内科AECOPD患者病原菌分布及抗菌药物使用分析Δ

Analysis of Pathogenic Distribution and Antibiotics Use of AECOPD Patients in Respiratory Department of Our Hospital

目的:为AECOPD患者合理使用抗菌药物提供参考。方法:回顾性分析我院呼吸内科2014-2015年慢性阻塞性肺疾病急性加重期(AECOPD)患者的病原菌分布及抗菌药物使用情况,对其感染部位、病原菌分布、抗菌药物使用(包括用药目的、药品名称、用法、用量、用药起止时间、给药途径、联用情况)、发生感染和并发症等进行统计分析。结果:967例AECOPD患者中,痰培养阳性619例(64.01%),共分离出病原菌774株,其中革兰氏阴性菌542株(70.03%),革兰氏阳性菌232株(29.97%);铜绿假单胞菌居首位(207株,26.72%)。有765例患者使用了抗菌药物,抗菌药物使用率为79.11%。其中,使用1种抗菌药物的患者有276例(36.08%),使用2种抗菌药物的患者有435例(56.86%),使用3种及以上抗菌药物的患者有54例(7.06%)。使用频率前3位的药品是左氧氟沙星注射液(455例次,47.05%)、莫西沙星注射液(241例次,24.92%)和注射用头孢美唑钠(192例次,19.86%)。联合用药方案排序前3位的是注射用头孢美唑钠+左氧氟沙星注射液(107例次,21.88%)、注射用头孢西丁+左氧氟沙星注射液(96例次,19.63%)和注射用拉氧头孢+左氧氟沙星注射液(65例次,13.29%)。结论:AECOPD患者抗感染治疗方案的制订应依据相应指南,分析患者可能感染的致病因素,重视病原学检查,尽早做病原菌培养和药敏试验,合理、科学、安全、规范地应用抗菌药物,从而达到较好的治疗效果,减少耐药菌株的产生。

OBJECTIVE：To provide reference for rational use of antibiotics in patients with AECOPD. METHODS：The pathogen distribution and antibiotics use of AECOPD patients was analyzed in respiratory department of our hospital during 2014-2015.The infection site,pathogen distribution and antibiotics use（including medication purpose,drug name,usage,dosage,medication duration,route of administration,drug combination）,infection and compliance were investigated and analyzed statistically. RESULTS：Among 967 AECOPD patients,there were 619 cases of positive sputum culture（64.01%）. A total of 774 strains were isolated,including 542 strains of Gram-negative bacterial（70.03%）and 232 strains of Gram-positive bacterial（29.97%）;most of them were Pseudomonas aeruginosa（207 strains,26.72%）. 765 patients were treated with antibiotics,and utilization ratio of antibiotics was 79.11%. 276 cases were treated with one kinds of antibiotics（36.08%）,435 treated with 2 kinds of antibiotics（56.86%）and 54 treated with 3 kinds of antibiotics and above（7.06%）. Top 3 drugs in the list of frequency were Levofloxacin injection（455 cases/times,47.05%）,Moxifloxacin injection（241 cases/times,24.92%）and Cefmetazole for injection（192 cases/times,19.86%）. Top 3 drug combination regimen were Cefmetazole for injection ＋ Levofloxacin injection（107 cases/times,21.88%）,Cefoxitin for injection＋Levofloxacin injection（96 cases/times,19.63%）and Moxalactam for injection＋Levofloxacin injection（65 cases/times,13.29%）. CONCLUSIONS：Anti-infective therapy regimen of AECOPD patients should be formulated according to relevant guideline,and pathogenic factors of infection are analyzed. Great importance should be attached to reasonable,scientific,safe and standard use of antibiotics,etiological examination;pathogenic bacteria culture and drug sensitivity test should be conducted as soon as possible. So as to obtain better therapeutic efficacy and reduce the generation of drug-resistant strain.