呼吸道感染病原菌分布与耐药性分析及抗菌药物治疗的疗效-成本对比

Distribution and drug resistance of pathogens causing respiratory tract infection and cost-effectiveness analysis of antibiotics therapy

目的研究分析呼吸道感染患者病原菌分布及耐药性,同时对比不同抗菌药物治疗的效果以及经济成本。方法选取医院从2014年10月-2016年9月间收治的120例呼吸道感染患者为本次研究对象,采集所有对象的痰液、血液、尿液等标本进行病原菌培养分离,并进行药敏试验分析其耐药性,遵照随机分配原则从1至120进行排序,随机分为4个小组,即1、2、3、4组,分别给予4种不同抗菌药物治疗,观察记录4组患者的临床治疗效果以及治疗费用,并进行组间对比分析。结果此次纳入120例患者中,培养分离134株病原菌,包括革兰阴性菌、革兰阳性菌以及真菌,其中革兰阴性菌占比最大;药敏试验结果显示革兰阴性菌中亚胺培南与美罗培南的敏感率较高,而革兰阳性菌中万古霉素敏感性极高;应用4种不同抗菌药物治疗结果显示,其临床治疗效果差异不明显,且均未造成严重不良反应发生,但1、2组患者治疗平均费用明显低于3、4组,组间数据差异较大(P<0.05),但1、2组患者治疗费用无统计学意义。结论呼吸道感染患者其主要致病菌为革兰阴性菌,其中亚胺培南与美罗培南的耐药性较低,应用不同抗菌药物治疗取得效果较为一致,但从经济角度考虑,左氧氟沙星与头孢曲松能够降低经济负担。

OBJECTIVE To investigate the distribution and drug resistance of pathogens isolated from the patients with respiratory tract infection and observe the effects of antibiotics as well as the economic costs.METHODS A total of 120 patients with respiratory tract infection who were treated in the hospital from Oct 2014 to Sep 2016 were recruited as the study objects.The sputum,blood and urine specimens were collected from all of the study objects,the pathogens were isolated,and the drug susceptibility testing was performed.The enrolled patients were randomly divided into 4 groups in an order of ranking from 1 to 120,namely the group 1,2,3 and 4,which were respectively treated with 4 different types of antibiotics.The clinical curative effects and treatment costs were observed and compared among the 4 groups of patients.RESULTS Totally 134 strains of pathogens were isolated from the 120 patients,including gram-negative bacteria,gram-positive bacteria and fungi,and the gram-negative bacteria were dominant among the pathogens.The result of drug susceptibility testing indicated that the gramnegative bacteria were highly susceptible to imipenem and meropenem,and the gram-positive bacteria were extremely susceptible to vancomycin.The result of the treatment with 4 types of antibiotics indicated that there was no significant difference in the clinical curative effect,without leading any severe adverse reactions,however,the average treatment costs were significantly less in the group 1 and 2 than in the group 3 and 4（P〈0.05）,however,there was no significant difference in the treatment cost between the group 1 and the group 2.CONCLUSIONS The gram-negative bacteria are dominant among the pathogens causing the respiratory tract infection,and the drug resistance rates to imipenem and meropenem are low.The different types of antibiotics can achieve the same curative effect,from the economic perspective,however,levofloxacin and ceftriaxone may reduce the economic burden.