抗菌药物轮替政策对医院革兰阴性菌耐药性的影响分析

Influence of Antibiotic Rotation Policy on Antibiotic Resistance of Gram Negative Bacteria in a Hospital

目的分析抗菌药物轮替政策对革兰阴性菌检出率和耐药率的影响。方法比较云南省第二人民医院实行抗菌药物轮替政策前后大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌及鲍曼不动杆菌的耐药率。结果第1轮抗菌药物轮替后,大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌及鲍曼不动杆菌对轮替停用的头孢他啶、头孢吡肟及氨曲南的耐药率均明显下降,对某些其他药物的耐药率也下降,但肺炎克雷伯菌对碳青霉烯类药物的耐药率上升;恢复使用头孢他啶及头孢吡肟后,几种革兰阴性菌耐药率趋于稳定或上升。结论实行抗菌药物轮替政策后,革兰阴性菌耐药率下降,但恢复被轮替抗菌药物的使用后,其耐药率趋于稳定或上升。

Objective To analyze the influence of antibiotic rotation policy （ ARP ） on relevance ratio and antibiotic resistance rate of gram negative bacteria. Methods The antibiotic resistance rate of Escherichia coli, Klebsiella pneumonia, Pseudomonas aeruginosae and Acinetobacter baumannii were compared before and after the ARP practiced in The Second People′s Hospital of Yunnan Province. Results After the first round of ARP, the antibiotic resistance rate of Escherichia coli, Klebsiella pneumonia, Pseudomonas aeruginosae and Acinetobacter baumannii to ceftazidime, cefepime and aztreonam which had been ceased during ARP were descending, and the trend was the same in some other kind of antibiotics, while the resistance of Klebsiella pneumonia to carbapenems increased simultaneously. After ceftazidime and cefepime had been desterilized, the resistance of gram-negative bacteria was stable or significantly risen. Conclusion After the implementation of ARP, the resistance rate of gram negative bacteria decreased, and it tends to be stable or rising when those antibiotics were desterilized.