2001—2005年某院抗生素使用情况及革兰阴性细菌耐药性分析  

The use of antibiotics and drug resistance in a hospital:a periodic report on years 2001 to 2005

作　　者：段金菊[1] 刘卓拉[2] 张润梅[1] 张瑞琴[1] 杜娟[1] 刘国栋[1] 徐辉[1] 康建帮[1] 

机构地区：[1]山西医科大学第二医院药剂科,太原030001 [2]山西医科大学第二医院呼吸科,太原030001

出　　处：《中国药物与临床》2007年第2期98-102,共5页Chinese Remedies & Clinics

基　　金：山西省科技攻关项目(051095-5)

摘　　要：目的了解2001—2005年抗生素使用情况和使用水平以及临床分离的非发酵革兰阴性杆菌及部分肠杆菌科革兰阴性杆菌的耐药现状,为科学合理使用该类抗生素提供必要参考依据。方法调查山西医科大学第二医院2001—2005年5年间抗生素的使用消耗情况以及临床药敏试验结果,采用世界卫生组织(WHO)推荐的限定日剂量(DDD)法分析各种抗菌药的用药频度(DDDs);用VITEK2系统对临床分离菌株进行鉴定,采用K-B纸片扩散法及VITEK2系统对所分离的革兰阴性杆菌进行药敏试验,用2004版美国实验室标准化委员会(CLSI)标准对结果进行判定,用WHONET5.3软件对数据进行统计学分析。结果5年来革兰阴性杆菌分离株除2003年外呈逐年上升趋势,其构成比分别为41.0%、40.0%、45.3%、37.0%、54.0%;非发酵革兰阴性杆菌逐年上升,尤其是鲍曼不动杆菌2004、2005年其分离分别达到了182、334株,而2001年只有21株;非发酵革兰阴性杆菌耐药率普遍较高,鲍曼不动杆菌除对亚胺培南仍保持着较好的敏感性外(≤10.0%),对其他抗生素2004年以后耐药率几乎都超过了50.0%,对头孢哌酮+舒巴坦的耐药率2005年达到42.0%;在肠杆菌细菌中对亚胺培南的耐药率都很低,几乎为0,对头孢哌酮+舒巴坦的耐药率除阴沟肠杆菌外,其耐药率大部分在30.0%以下;在肠杆菌细菌中耐药最严重的为阴沟肠杆菌,除对亚胺培南外,对其他抗生素几乎都超过了50.0%。在对抗生素的使用调查中,抗生素的总DDDs2003年达到高峰,以后有下降趋势;销售金额逐年上升,但与年总药物销售金额构成比2003年达高峰,占42.8%,以后逐年下降,2005年占28.2%;头孢霉素在5年间的DDDs没有太大的变化,但复合制剂的DDDs在2004、2005年上升幅度很大,亚胺培南的DDDs5年来虽略有增加但仍保持DDDs较低水平,分别为133,140,157,254,422。喹诺酮类在连续高的DDDs后,2005年有所下降。结论细菌耐药与抗�Objective To investigate into the use of antibiotics against and the aspects of drug resistance in nonfermenting Gram-negative bacilli and part of enterobacter family isolated in our hospital, so as to provide a rationale for proper use of antibiotics. Methods The use of antibiotics and outcomes from clinical sensitivity test during 2000--2005 were reviewed. Frequencies （defined daily dose, DDD） and duration （days） of antibiotic medication was evaluated according to the WHO-recommended DDD method. Clinical isolates of bacteria were identified by VITEK2. Antibiotic susceptibility test was completed by Kirby-Bauer method and VITEK2. The result was assessed based on the CLSI criteria 2004. Statistical analysis was performed using WHONETS.3 software package. Results Overall, the rates of Gram-negative bacilli isolation have been on the rise during these 5 years, except for 2003, turning out to be 41.0%, 40.0%, 45.3%, 37.0% and 54.0%, respectively. Among nonfermenting gram-negative bacilli, the number of Acinetohacter haumannii experienced a sharp increase from 21 in 2001 to 182 in 2004 and 334 in 2005. Resistance rates were found to be generally higher in nonfermenting gram-negative bacilli. In particular, over 50% of Acinetobacter baumannii were resistant to majority of tested antibiotics after 2004, except in terms of Imipenem （ ≤ 10.0% for all years） and cefoperzone/sulhactam （42.0% in 2005）. Enterobacteriaecae members were nearly 100% susceptible to Imipenem. Resistance to cefoperzone/sulhactam was mostly below 30.0% except in Enterebacter cloacae. The Enterohacter cloacae showed higher resistance rates to all antibiotics （〉50.0%） other than Imipenem. With regards to the use of antibiotics during 2001-2005, the DDDs peaked in 2003 and declined afterwards. While the sales of antibiotics have been rising during 2001-2005, the ratio of antibiotics to annual medicine sales has decreased to 28.2% in 2005,after its peak （42.8%） observed in 2003. The total DDDs of Cephalosporins remained mode

关 键 词：抗生素使用 用药频度 细菌耐药 

分 类 号：R446.5[医药卫生—诊断学]