某院住院患者抗菌药物使用量与细菌耐药分析

Analysis on consumption of antibacterials and bacterial resistance in a certain hospital

目的:分析抗菌药物使用量及临床分离菌对常用抗菌药物耐药情况,为临床合理用药提供参考。方法:统计和分析2012-2013年住院患者抗菌药物用药频度(DDDs)及主要临床分离菌对常用抗菌药物的耐药性。结果:2年间临床选择以头孢菌素类、喹诺酮类、头霉素类及其他β-内酰胺类抗菌药物为主,2013年较2012年DDDs变化显著的抗菌药物主要有头孢呋辛、头孢曲松、头孢美唑、头孢西丁、帕珠沙星、磷霉素等。与2012年比较,2013年大肠埃希菌、肺炎克雷伯菌对头孢呋辛、头孢美唑、磷霉素耐药率均呈现上升(P<0.05~P<0.01);鲍曼不动杆菌对头孢美唑和磷霉素耐药率均超过80%,均呈现上升(P<0.05和P<0.01);金黄色葡萄球菌对左氧氟沙星耐药率明显上升(P<0.01)。结论:抗菌药物DDDs与细菌耐药性有一定相关性,DDDs升高,细菌耐药性明显升高;DDDs下降,部分细菌耐药性有所降低。医院应积极开展细菌耐药性监测,采取有效措施控制抗菌药物的用量,促进临床合理使用抗菌药物,减少细菌耐药性的产生。

Objective：To investigate the consumption of antibacterials and the drug resistance of the bacteria isolated from clinical samples for rational use of antibacterials.Methods：The defined daily dose（DDDs） of inpatients and the drug resistance of the bacteria isolated from clinical samples in 2012-2013 were analyzed.Results：In the 2 years from 2012 to 2013,the main clinical drug selection was cephalosporins,quinolones,cephamycins and other β-lactamase inhibitors.The drugs of great variation of DDDs included cefuroxime,ceftriaxone,cefmetazole,cefoxitin,pazufloxacin and fosfomycin.In 2013,the resistance rates of Escherichia coli,Pseudomonas aeruginosa all increased for cefuroxime,cefmetazole and fosfomycin（P〈0.05 to P〈0.01）;the resistance rate of Acinetobacter baumannii all exceed 80% for cefmetazol and fosfomycin（P〈0.05 and P〈0.01）,the resistance rate of Staphylococcus aureus increased significantly for levofloxacin（P〈0.01）.Conclusions：There was a positive correlation between the DDDs and bacterial resistance,with the increasing of DDDs,the bacterial resistance increased significantly;when DDDs fell,portion of bacterial resistance decreased.Active surveillance of bacterial resistance in hospital and effective measures to control the amount of antibacterials,guidance of clinical rational drug use should be carried out to reduce bacterial resistance.