我院2005-2011年重症急性胰腺炎患者抗菌药物应用分析  

Analysis of Antibiotics Use in Patients with Severe Acute Pancreatitis in Our Hospital from 2005 to 2011

作　　者：何文富[1] 曾永保[1] 陈乾[1] 

机构地区：[1]宜宾市第一人民医院药剂科,四川宜宾644000

出　　处：《中国药房》2013年第22期2026-2030,共5页China Pharmacy

摘　　要：目的:了解我院重症急性胰腺炎(SAP)患者的抗菌药物应用情况。方法:对我院2005-2011年收治的276例SAP患者感染病原菌的流行病学特点和耐药性监测结果、临床应用抗菌药物的品种选择、用法用量和用药频度(DDDs)等资料进行回顾性统计分析。结果:276例SAP患者均为继发感染,感染部位主要位于胰腺、胰周和腹腔。临床共培养、分离和鉴定出病原菌269株,其中革兰阴性(G-)杆菌有226株(81.9%)、6种;最常见的为G-杆菌和厌氧菌,其次为肠球菌属、葡萄菌属、真菌等。临床应用第3代头孢菌素(包括含酶抑制剂的复方制剂)的DDDs最高(累计DDDs达10985),成为SAP患者继发感染临床应用最广泛的抗菌药物。产超广谱β-内酰胺酶(ESBLs)耐药菌株和ESBLs的检出率逐渐增多,大肠埃希菌、肺炎克雷伯菌、产气肠杆菌、阴沟肠杆菌和鲍曼不动杆菌等5种G-杆菌对头孢他啶的耐药率均在70%以上,铜绿假单胞菌对头孢他啶的耐药率也在50%以上;6种G-杆菌对环丙沙星的耐药率已在60%以上。大肠埃希菌和肺炎克雷伯菌对亚胺培南、头孢哌酮/舒巴坦等均保持较低的耐药率(0～28.3%);6种G-杆菌对头孢哌酮/舒巴坦和哌拉西林/他唑巴坦的耐药率均在40%以下,对亚胺培南的耐药率在30%以下。结论:及时、合理地对SAP继发感染患者应用抗菌药物对其预后极为重要。对SAP继发感染选择抗菌药物既要考虑到药物穿透感染部位组织特别是血胰屏障的能力,又要注意相关病原菌的流行病学特点和耐药性监测结果。OBJECTIVE： To investigate the application of antibiotics in severe acute pancreatitis （SAP） patients in our hospital. METHODS： A total of 276 SAP patients admitted in our hospital from 2005 to 2011 were enrolled to make a survey; their clinical data such as characteristics of infection etiology and resistance monitoring results, varieties selection of antibiotics, dosage and us- age and DDDs were respectively analyzed. RESULTS： All of 276 SAP cases were developed secondary infection, and the main in- fection sites located in pancreas, peripancrea and abdominal cavity. 269 infectious bacterial strains were cultivated for bacterial cul- ture and identified from clinical specimens, among which 226 strains （81.9%） including 6 categories were Gram-negative bacilli. The most common infectious pathogens were Gram-negative bacilli and anaerobe, followed by Enterococcus, Staphylococcus and fungi, etc. Clinical application of the third-generation cephalosporins （including compound preparations containing enzyme inhibi- tors） ranked first place of DDDs list （reaching 10 985）; they have become the most widely used to treat SAP patients secondary in- fection. Detection rates of drug-resistant strains of producing ESBLs and ESBLs gradually increased. Drug resistance rates of 5 kinds of Gram-negative bacilli, such as Escherichia coli, Klebsiella pneumoniae, Enterobacter aerogenes, Enterobacter cloacae and Acinetobacter baumannii, to ceftazidime were above 70% ; that of Pseudomonas aeruginosa to ceftazidime were above 50% ; that of 6 kinds of Gram-negative bacilli to ciprofloxacin were above 60%, but E. coli and K. pneumoniae kept low drug resistance to imipenem, cefoperazone/sulbactam （0-28.3%） ; that of 6 kinds of Gram-negative bacilli to cefoperazone/sulbactarn and piperacil- lin/tazobactam was below 40%, and that of them to imipenem was below 30%. CONCLUSIONS： Both timely and rational use of antibiotics is very important to prognosis for SAP secondary infection patients. It is not only necessary t

关 键 词：抗菌药物 重症急性胰腺炎 继发感染 

分 类 号：R969.3[医药卫生—药理学] R287[医药卫生—药学]