专项整治前后医院抗菌药物使用情况及对细菌耐药性的影响

Influence on Use of Antibiotics and Bacterial Drug Resistance in the Hospital Before and After Special Rectification Activities

目的 分析实施专项整治活动前后医院抗菌药物使用情况及对细菌耐药性的影响。方法 采用对照法,对比医院专项整治活动前（2015年1月至6月）和整治活动后（2015年7月至12月）抗菌药物使用情况并对细菌耐药性进行分析。结果 整治后,住院患者抗菌药物使用率由78.59%降至57.64%;住院患者抗菌药物使用强度由84.25 DDDs/（100人·天）降至41.36 DDDs/（100人·天）;Ⅰ类切口手术患者预防使用抗菌药物比例由89.41%降至28.76%;急诊患者抗菌药物处方比例由46.48%降至24.35%;门诊患者抗菌药物处方比例由35.63%降至11.29%;微生物检验标本送检率由19.91%上升至46.25%。整治后,居前5位的多重耐药菌为大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌和金黄色葡萄球菌;肺炎克雷伯菌对第1-3代头孢菌素类药物耐药率有增高趋势,对诺氟沙星等耐药率降至10.00%,对头孢噻肟等耐药率降至20.00%以下;大肠埃希菌对哌拉西林耐药率仍保持在70.00%以上,对亚胺培南等耐药率保持在1.00%以下,对阿米卡星等耐药率降至10.00%以下;铜绿假单胞菌对庆大霉素等抗菌药物耐药率多数降至20.00%以下;鲍曼不动杆菌对哌拉西林等抗菌药物耐药率保持在60.00%以上,且对多种抗菌药物（尤其对碳青霉烯类抗菌药物）的耐药率明显上升;金黄色葡萄球菌对青霉素G耐药率高达90.00%以上,对左氧氟沙星等抗菌药物耐药率降至30.00%以下,对他唑巴坦等抗菌药物耐药率保持在20.00%以下,对万古霉素、利奈唑胺未产生耐药性。结论 专项整治活动后,医院抗菌药物使用更加合理,可降低细菌耐药性。

Objective To analyze the influence on use of antibiotics and bacterial drug resistance in the hospital before and after special rectification activities. Methods Use of antibiotics and bacterial drug resistance were used by the control method to analyze before （January to June 2015） and after special rectification activities （July to December 2015）. Results Usage rate of antibiotics of hospitalized patients decreased to 57.64% after the rectification from 78.59%, and the usage intensity decreased to 41.36 DDDs/（100 cases/d） from 84.25 DDDs/（100 cases/d）. Preventive usage of antibiotics of patients of Type-I incision surgery decreased to 28.76% from 89.41%. The proportion of antibiotics prescription in emergency patients decreased to 24.35% from 46.48%, and in outpatients to 11.29% from 35.63%.The inspection rate in microbiological test specimen increased to 46.25% from 19.91%.The former five multi drugs resistant bacteria were escherichia coli, pseudomonas aeruginosa, acinetobacter bauman, klebsiella pneumoniae and staphylococcus aureus. After the rectification, it showed the increasing tend of klebsiella pneumoniae on drug resistance rate, and decreasing to 10.00% on norfloxacin, etc drugs, and decreasing to 20. 00% on cefotaxime, etc drugs. Escherichia coli on resistance rate of piperacillin remained at more than 70.00%, and imipenem remained at less than 1.00%, and amikacin increased to less than 10.00%. Pseu- domonas aeruginosa on resistance rate of gentamicin and other antibiotics almost decreased to less than 20.00%. Bauman acinetobacter on resistance rate of piperacillin remained above 60.00%, and it increased significantly on many kinds of antibiotics, especially on carbapenem antibiotics. Staphylococcus aureus on resistant rate of penicillin G was as high as 90.00%, and levofloxacin antimicrobial decreased to below 30. 00%, and tazobactam and other antimicrobial drugs remained below 20. 00%, and on vancomycin and linezolid with no drug resistance. Conclusion After special rectification activities, use of antibiotics in our hospital is more reasonable, and it can reduce the bacterial drug resistance.