医院骨科感染患者的抗菌药物应用情况调查与耐药性分析

Use of antibiotics by patients with nosocomial infections in department of orthopedics and drug resistance

目的调查医院骨科感染患者的抗菌药物应用情况,并对患者病原菌的临床耐药性进行系统分析,以便为临床抗菌药物的合理应用提供参考依据。方法选取医院骨科2014年12月-2016年12月收治的住院患者为研究对象,调查感染患者抗菌药物使用强度、病原菌分布,并对检出病原菌的临床耐药性进行分析。结果抗菌药物种类应用排名前3位的分别是头孢菌素类、β-内酰胺类和青霉素类,构成比分别为60.88%、18.00%和10.81%;抗菌药物应用排名前5位的分别是氨苄西林、头孢他啶、头孢唑肟、头孢西丁、阿奇霉素,构成比分别为17.19%、14.76%、9.06%、8.99%、8.49%;31 002份样本中共检出病原菌3 989株,检出率为12.87%;其中,革兰阴性菌1245株占31.21%,革兰阳性菌2302株占57.71%,真菌442株占11.08%;大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌对苯唑西林、青霉素和氨苄西林的临床耐药率较高,耐药率为80.51%~97.62%;表皮葡萄球菌、人葡萄球菌和溶血葡萄球菌对氨苄西林、甲氧苄啶和头孢他啶的临床耐药率较高,耐药率为80.83%~100.00%。结论骨科抗菌药物主要采用头孢他啶、氨苄西林等,临床检出的病原菌以革兰阳性菌为主,抗菌药物的耐药性较为严重。

OBJECTIVE To investigate the status of use of antibiotics by the patients with nosocomial infections in department of orthopedics and systematically analyze the clinical drug resistance of pathogens so as to provide guidance for reasonable use of antibiotics.METHODS The hospitalized patients who were treated in department of orthopedics from Dec 2014 to Dec 2016 were recruited as the study objects.The antibiotics use intensity and distribution of pathogens of the patients with the infections were investigated,and the clinical drug resistance of the isolated pathogens was observed.RESULTS Cephalosporins,β-lactams and penicillins ranked the top 3 categories of applied antibiotics,accounting for 60.88%,18.00% and 10.81%,respectively.Ampicillin,ceftazidime,ceftizoxime,cefoxitin and azithromycin ranked the top 5 antibiotics,accounting for 17.19%,14.76%,9.06%,8.99%and 8.49%,respectively.A total of 3989 strains of pathogens were isolated from 31002 samples,with the isolation rate 12.87%;there were 1245（31.21%）strains of gram-negative bacteria,2302（57.71%）strains of gram-positive bacteria and 442（11.08%）strains of fungi.The Escherichia coli,Klebsiella pneumoniae and Enterobacter cloacae were highly resistant to oxacillin,penicillin and ampicillin,with the drug resistance rates ranging between80.51% and 97.62%;the Staphylococcus epidermidis,Staphylococcus hominis and Staphylococcus haemolyticus were highly resistant to ampicillin,trimethoprim and ceftazidime,with the drug resistance rates ranging between 80.83% and 100.00%.CONCLUSION Ampicillin and ceftazidime are the most commonly used antibiotics in the orthopedics department.The gram-positive bacteria are dominant among the isolated pathogens and are highly resistant to antibiotics.