907株多重耐药菌的分布及临床药师对其药物治疗的干预

Distribution of 907 Cases of Multi-Resistant Bacteria and Its Drug Treatment Interventions by Clinical Pharmacists

目的:探讨临床药师参与多重耐药菌监测及治疗过程的药学实践,为临床合理用药提供参考。方法:分析2016年7—12月龙岩市第二医院(以下简称"我院")907株多重耐药菌的分布与构成,提出用药建议,个体化干预多重耐药菌检出患者的抗菌药物治疗方案。结果:多重耐药菌主要分离自痰液、尿液。907株多重耐药菌中,革兰阴性菌与革兰阳性菌占比分别为64.8%(588株)、35.2%(319株);结构分布方面,多重耐药细菌886株(占97.7%),广泛耐药细菌7株(占0.8%),泛耐药细菌14株(占1.5%);菌株数排序居前3位的依次为产超广谱β-内酰胺酶细菌(376株,占41.5%)、耐甲氧西林凝固酶阴性葡萄球菌(195株,占21.5%)和耐甲氧西林金黄色葡萄球菌(70株,占7.7%)。临床药师根据患者体征及实验室检查结果等综合制订抗感染方案,临床依从率高,有效率高。结论:我院临床细菌多重耐药现象较严重,临床药师综合考虑患者临床体征,较好地把握用药适应证,保证了患者的用药安全、有效。

OBJECTIVE： To probe into the pharmaceutical practice for monitoring and treatment process of multiresistant bacteria with the help of clinical pharmacists,so as to provide reference for the rational drug use in clinic.METHODS： Analysis was conducted on distribution and constitute of 907 strains of multi-resistant bacteria in the Second Hospital of Longyan during Jul.-Dec. 2016,drug use suggestions was put forward; therapeutic regimen of individulized intervention of antibiotics on patients were detected with multiple resistance bacteria. RESULTS： Multiresistant bacteria were mainly separated from sputum and urine. Of the 907 strains of multi-resistant bacteria,ratio of gram-negative bacteria and gram-positive bacteria were respectively 64. 8%（ 588 strains） and 35. 2%（ 319 strains）.As for distribution structure,multi-resistant bacteria were 886 strains（ 97. 7%）,extensively drug-resistant bacteria was 7 strains（ 0. 8%）,and pan-resistant bacteria was 14 strains（ 1. 5%）. The top 3 drug-resistant bacteria ranked by number were respectively extended-spectrum β-lactamases bacteria（ 376 strains,41. 5%）,methicillin-resistant staphylococcus aureus（ 195 strains,21. 5%） and methicillin-resistant staphylococcus aureus（ 70 strains,7. 7%）.According to the clinical signs and laboratory examinations,the clinical pharmacists formulated the anti infection program,with high clinical compliance and high efficiency. CONCLUSIONS： The clinical isolated of multi-resistant bacteria in our hospital are serious. Clinical pharmacists should grasp the indications by the clinical signs of patients,and improve the safety,effectivity and rationality of medication in patients.