2012年至2014年十种病原菌分布和耐药性分析

Distribution and resistant analysis of ten kinds of drug-resistant bacteria from 2012 to 2014

目的：分析沂水中心医院住院患者抗菌药物使用和十种病原菌检出率之间的相关性，总结对十种耐药菌敏感的抗菌药物，为临床合理应用抗菌药物提供参考。方法按年度调取沂水中心医院2012年至2014年抗菌药物使用例数、住院人数、住院天数、抗菌药物使用量，十种病原菌及其耐药率﹤30％的抗菌药物，并计算各年度抗菌药物使用强度。结果2012年至2014年我院住院患者抗菌药物使用率分别为63.2％、43.8％和42.1％，使用强度分别为64.0、41.4和34.7 DDD。2012年至2014年十种耐药菌检出率（株数/送检标本数）之和逐年降低，分别为7.63％、5.28％和2.55％。2014年 MRSA、大肠埃希菌（ESBLs）和肺炎克雷伯菌（ESBLs）三种细菌检出率分别为0.42％、1.34％和0.34％，较2012年和2013年均有所降低；2014年耐碳青酶烯类抗菌药物的细菌检出率为0.10％，比2012年和2013年有所增加；2013多重耐药菌和泛耐药菌检出率之和为1.13％，2014年为0.38％；2012年至2014年耐药率均﹤30％的抗菌药物中，MRSA 以万古霉素为主；产 ESBLs 的大肠埃希菌和肺炎克雷伯菌主要是碳青霉烯类和β-内酰胺酶抑制剂复合制剂；2014年耐碳青霉烯类病原菌以呋喃妥因、复方新诺明、头孢三代和四代、氟喹诺酮类药物和β-内酰胺酶抑制剂复合制剂为主；多重耐药的大肠埃希菌和铜绿假单胞菌主要是亚胺培南，泛耐药菌没有敏感药物。结论加强碳青霉烯类抗菌药物的管控力度，确保该类药物的合理使用迫在眉睫。降低抗菌药物使用率和使用强度可以降低病原菌检出率，延缓细菌耐药产生。

Objective To analyze relevance of antibacterial consumption with detectable rate of ten kinds of drug-resistant bacteria from 2012 to 2014 and summarize their sensitive antibacterial agents and thus to provide basis for clinical rational use of antimicrobial drugs. Methods To obtain annual an-timicrobial person,the number of inpatients and their length of stay,antimicrobial consumption,ten kinds of drug-resistant bacteria and antibiotics whose resistance rate lower than 30 percent from 2012 to 2014,and calculated antimicrobial use density every year. Results From 2012 to 2014,the antimicro-bial use rate of inpatients was 63. 2% ,43. 8% and 42. 1% ,and their use density was 64. 0,41. 4 and 34. 7 DDD. Detectable rate of ten kinds of drug-resistant bacteria was decreases year by year,and their sum of detectable rate was 7. 63% ,5. 28% and 2. 55% from 2012 to 2014 respectively. Detectable rate of methicillin-resistant staphylococcus aureus（MRSA）,extended spectrum beta-lactamases（ESBLs）-pro-ducing strains of escherichia coli and klebsiella pneumoniae was 0. 42% ,1. 34% and 0. 34% in 2014 re-spectively,which was all lower than 2012 and 2013. While detectable rate of bacterial resistant to carbon penicillium alkene was 0. 10% ,which was higher than that in 2012 and 2013. Total detectable rate of multi-resistant bacteria and drug-resistant bacteria was 1. 13% in 2013,and 0. 38% in 2014. Antimicro-bial kinds whose resistance rate lower than 30% was as follows,MRSA was mainly vancomycin,extended spectrum beta-lactamases（ESBLs）-producing strains of escherichia coli and klebsiella pneumoniae both focused on carbapenems and beta lactamase inhibitor compound preparation. Bacterial resistant to carbap-enem included macrodantin,compound sulfamethoxazole,third and fourth generation cephalosporin,flu-oroquinolone drugs and beta lactamase inhibitor compound preparation. Multiple drug-resistant escherich-ia coli and pseudomonas aeruginosa was imipenem,while generic drug resistant bacteria had no sensitive agents. Conclusions It is extremely urgent to strengthen carbon penicillium alkene antimicrobial drug control so as to ensure its reasonable use. Reduction of antimicrobial use rate and density could cut down detectable rate of patho-genic bacteria and slow down bacterial drug resistance.