2016年我院住院患儿抗菌药物应用情况及耐药性调查情况分析

Antimicrobial Agents Application and Drug Resistance Investigation in Hospitalized Children in our Hospital in 2016

目的 :分析2016年我院住院患儿抗菌药物应用情况及耐药性调查结果。方法 :从医院信息统计平台调取儿科病区2016年所有应用抗菌药物患儿的电子病历,采用随机分层抽样方法抽取其中95例住院患儿应用抗菌药物的数据,分析送检标本病原菌检出情况及常用抗菌药物耐药性,并总结抗菌药物不合理使用情况。结果 :(1) 95例患儿中,一联抗菌药物占80.00%,联合抗菌药物占20.00%;以治疗用药、预防用药为主(86.32%),治疗+预防用药相对较少(13.68%)。(2)所有抗菌药物使用频度(DDDs)为263.5,使用强度(AUD)为25.22。(3)共使用抗菌药物24种,149例次,DDDs排名前10位的抗菌药物包括头孢他啶、美洛西林、哌拉西林/他唑巴坦等,占总DDDs的80.49%,与例次率排名前10位的抗菌药物(占79.19%)一致。(4)送检样本中前6位非重复临床分离菌291株,革兰氏阴性菌占64.95%,革兰氏阳性菌占30.05%。(5)革兰氏阴性菌对氨曲南、头孢噻肟等抗菌药物耐药率较高,对阿米卡星、左氧氟沙星等耐药率较低;革兰氏阳性菌对青霉素、苯唑西林等抗菌药物耐药率较高,对左氧氟沙星、万古霉素等耐药率较低。(6)抗菌药物不合理使用现象主要为给药时机、疗程及药物品种选择不适宜。结论 :2016年我院住院患儿抗菌药物合理用药水平有待提高,细菌耐药形势不乐观,应根据药敏结果谨慎选择抗菌药物以进一步提高临床疗效,并加强抗菌药物的合理应用和规范化管理以控制细菌耐药率增长。

Objective To analyze the antimicrobial agents application and drug resistance investigation in hospitalized children in our hospital in 2016. Methods The electronic medical records of all the children treated with antimicrobial agents in the pediatric ward in 2016 were collected from the hospital information statistics platform, and the data of 95 hospitalized children treated with antibacterial drugs were extracted by random stratified sampling method. The bacteria detection of examined samples and the drug resistance of common antimicrobial were analyzed, and the unreasonable use of antimicrobial agents were summarized. Results(1)There were 80.00% of a combination of antimicrobial agents and 20.00% of combined antimicrobial agents among the 95 cases of children. Medication use for treatment or prevention were the main methods(86.32%), and medication use for treatment and prevention were relatively few(13.68%).(2)The use frequency of all antimicrobial agents(DDDs) was 263.5, and the use intensity(AUD) was 25.22.(3)There were 24 kinds of antimicrobial agents with 149 case-time antimicrobial agents, and the top 10 in the DDDs were ceftazidime, mezlocillin, piperacillin/tazobactam and etc, accounding for 80.49% in the total DDDs, and they were consistent with the antimicrobial agents in the top 10 case rates(79.19%).(4)There were 291 strains of non-repetitive clinical isolates with 64.95% of gram-negative bacteria and 30.05% of gram-positive bacteria.(5)The gram-negative bacteria was highly resistant to aztreonam, cefotaxime and other antimicrobial agents while was lowly resistant to amikacin and levofloxacin. And the gram-positive bacteria was highly resistant to penicillin, oxacillin and other antimicrobial agents while was lowly resistant to the levofloxacin and vancomycin.(6) The irrational use of antimicrobial agents were mainly the improper administration time, the treatment course and the drug varieties choice. Conclusion The antimicrobial agents use level needs to be improved for hospitalized children in our hospital in 2016, and the bacterial resistance situation is not optimistic, and the antibacterial agents should be carefully selected according to the drug sensitivity results to further improve the clinical efficacy, and the rational use of antibacterial agents and standardized management should be strengthened to control the increase of bacterial resistance rate.