细菌耐药机制指导在抗生素合理应用中的临床价值

Bacterial Resistance Mechanism Guiding the Clinical Value of Rational Application of Antibiotics

目的探讨细菌耐药机制指导在抗生素合理应用中的临床价值。方法选取该院2015年1月—2017年1月ICU收治的使用抗生素的患者,收集菌株814株。对收集的菌株进行药敏试验,对菌株的分布以及耐药情况进行分析统计。结果 814株肺炎克雷伯菌菌株主要分布在痰液(618株,75.92%)、创面分泌物(48株,5.90%)、中段尿(38株,4.66%)、胸腹水(30株,3.69%)中。814株肺炎克雷伯菌产ESBLs226株,非产ESBLs588株,其中ESBLs耐药情况主要以复方新诺明(146株,64.60%)、氨曲南(122株,53.98%)、头孢呋辛(114株,50.44%)、头孢噻肟(110株,48.67%)、头孢吡肟(106株,46.90%)为主;非产ESBLs耐药情况主要以复方新诺明(226株,45.38%)、头孢唑啉(214株,36.39%)、头孢噻肟(194株,32.99%)、头孢呋辛(146株,24.83%)、氨曲南(138株,23.47%)为主。结论细菌耐药情况相对较高,菌株对亚胺培南最为敏感,治疗应当作为首选,对头孢类复合制剂相对敏感,也可作为治疗药物,临床中应当交叉联合用药,避免耐药产生。

Objective This paper tries to explore the clinical value of antibiotic resistance mechanism guidance in rational use of antibiotics. Methods Patients with antibiotics treated at the ICU from January 2015 to January 2017 were selected and 814 strains were collected. The susceptibility test was conducted on the collected strains, and the distribution and drug resistance of the strains were analyzed and counted. Results 814 strains of Klebsiella pneumoniae were mainly distributed in sputum（618 strains, 75.92%）, wound exudate（48 strains, 5.90%）, middle urine（38 strains,4.66%）, pleural effusion（30 strains, 3.69%）. 814 strains of Klebsiella pneumoniae produced 226 strains of ESBLs and558 non-ESBLs strains. Among them, the resistance of ESBLs was mainly compound sulfamethoxazole（146 strains,64.60%）, aztreonam（122 strains, 53.98%）, cefuroxime（ 114 strains, 50.44%）, cefotaxime（110 strains, 48.67%） and cefepime（106 strains, 46.90%） were the main strains; non-ESBLs resistant strains were mainly compound sulfamethoxazole（226 strains, 45.38%）, cefazolin（214 strains, 36.39%）, cefotaxime（194 strains, 32.99%）, cefuroxime（146 strains,24.83%）, and aztreonam（138 strains, 23.47%） dominated. Conclusion Bacterial drug resistance is relatively high.Strains are most sensitive to imipenem, and treatment should be the first choice. They are relatively sensitive to cephalosporin compound preparations and can also be used as therapeutic drugs. Cross-conjoined drugs should be used in clinical practice to avoid drug resistance.