Ampc酶与常见抗生素用药时间关系的探讨及其院内分布监测  

Investigation of Long-time Antibiotics Use for Gram-Negative Bacilli with H-Ampc and Their Distribution Patterns in a Hospital

作　　者：林立中[1] 

机构地区：[1]湖南省常德市第一人民医院检验科,湖南常德415003

出　　处：《实用预防医学》2010年第5期986-987,共2页Practical Preventive Medicine

摘　　要：目的探讨Ampc酶与用药时间的关系,监测高产酶菌株院内的分布,指导临床合理用药。方法利用头孢西丁初筛和三维确证试验检测Ampc酶,回顾性比较用药时间及种类差异,统计高产酶株在各科室的分布。结果革兰阴性杆菌高产Ampc酶的总检出率15.1%;阴沟杆菌、铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌的总检出率分别为20.5%、63.0%、4.8%、1.0%;高产酶菌株三代头孢平均用药时间(7.72±1.57)d;非高产株平均用药时间(2.91±0.5)d;主要科室分布:ICU19.5%、外科14.4%、血液肿瘤科14.3%、呼吸科10.2%。结论高产酶株的产生与用药时间及种类有关;我院革兰阴性杆菌高产Ampc酶菌株的总检出率明显高出国内平均报导水平[1,2];三代头孢长时间频繁使用是导致高产Ampc酶菌的主要因素;这对临床用药有重要参考意义。Objective To explore the relationship between Arnpc and the time of using antibiotics, to monitor the distribution patterns and positive rate of the H-Ampc isolates in the First People＇s Hospital of Changde, and to select antibiotics correctly according to the results. Methods Modified three dimensional test and screening test were used to detect Ampc β - lactamase producing by Gram - negative bacilli. The using time and the types of antibiotics were retrospectively compared in every patient. The distribution of Gramnegative bacilli with high Ampc in all the departments of the hospital was statistically analyzed. Results The total positive rate of Ampc enzyme producing by Gramnegative bacilli was 15.1%. The total positive rate of Ampc enzyme in Enterobacter cloacae, Pseudornonas aerusinosa , Acinetobacter baumanii , and Escherichia coll was 20.5%, 63.0%, 4.8%, and 1.0%, respectively. Statisticsed the third generational β- lactarn antibiotics using time between H - Ampc and N - HAmpc, the former was （7.72 ±1.57 ） days, and the latter was （ 2.91 ± 0.5） days. Gram - negative bacilli with H- Ampc were mainly distributed in ICU （19.5%）, department of surgery （14.4%）, department of hematology and oncology（ 14.3 % ）, and department of respiratory disease （ 10.2 % ）. Conclusions H - Arnpc producing by Gram- negative bacilli is related to the using time and the types of antibiotics. The total positive rate of H- Ampc producing by Gramnegative bacilli in our hospital is significantly higher than the average level of the whole nation. Longtime and un- reasonable use of the third generational β - lactam antibiotics is the main cause of H - Ampc producing by Gram - negative bacilli. It has great reference value for the clinicians＇ rational use of antibiotics.

关 键 词：突变 AMPC酶 革兰阴性杆菌 

分 类 号：R978.1[医药卫生—药品]