我院2010～2012年住院患者细菌耐药监测及抗菌药应用分析  

Surveillance of Bacterial Resistance and Analysis of the Utilization of Antibacterial Drugs in Patients of our Hospital from 2010 to 2012

作　　者：钱成兰[1] 王萍[1] 赵水娣[1] 蔡恵恵 陈加会[2] 

机构地区：[1]南京医科大学第二附属医院药剂科,南京210011 [2]南京医科大学康达学院

出　　处：《药物流行病学杂志》2014年第4期242-248,共7页Chinese Journal of Pharmacoepidemiology

摘　　要：目的：了解我院2010～2012年住院患者病原菌分布和细菌耐药变迁及抗菌药使用情况，为临床合理应用抗菌药提供参考。方法： 对我院3年间临床分离的常见病原菌及耐药率进行统计分析；根据我院3年间住院药房药品管理记录，计算抗菌药的用药频度（DDDs）。结果：3年共分离出18 177株病原菌，其中主要的6种革兰阴性菌占54.77％、4种革兰阳性菌占19.09%。葡萄球菌属中MRSA和MRSCN的检出率3年分别为53.05%、47.32%、53.55%和80.64%、83.04%、83.29%；大肠埃希菌、肺炎克雷伯菌中产超广谱β 内酰胺酶（ESBLs）的检出率3年分别为63.34%、54.80％、38.00％和43.52%、35.30%、35.00%。葡萄球菌属、屎肠球菌和粪肠球菌对糖肽类抗菌药耐药率低，3年均〈6%；肠杆菌科细菌对碳青霉烯类仍保持较高的敏感率，耐药率基本〈20%，但呈逐年上升趋势；非发酵菌铜绿假单胞菌和鲍曼不动杆菌对各种抗菌药耐药率较高，对碳青霉烯类耐药率分别在20%～30%和30%～45%之间。2010～2012年抗菌药DDDs排序前2位的始终是头孢菌素类和青霉素类，排序第3位的分别是喹诺酮类、硝基咪唑类和大环内酯类抗菌药。抗菌药总DDDs呈逐年下降趋势，某些细菌的耐药率与抗菌药的DDDs有一定的关系。结论：应严格执行《抗菌药临床应用指导原则》，加强细菌耐药监测与抗菌药合理应用管理工作。限制广谱抗菌药的应用，延缓细菌耐药趋势。Objective：： To investigate the distribution of pathogen, change of bacterial resistance and utilization of antibacterial drugs in hospitalized patients of our hospital from 2010 2012 to provide reference for clinical reasonable application of antibiotics. Methods：The common pathogenic bacteria and resistance rate data collected from the clinical isolattion in 3 years were statistically analysed. According to the drug management records from the hospital pharmacy in 3 years, the antibacterial frequency of use （DDDs） was calculated. Results：A total of 18 177 strains of pathogens were isolated. Among them, 6 species of Gram negative bacteria and 4 species of Gram positive strains accounted for 54.77%and 19.09%. The detection rates of MRSA and MRSCN of staphylococcus in 3 years were 53.05%, 47.32%, 53.55%and 80.64%, 83.04%, 83.29%,and the detection rates of Escherichia coli, Klebsiella pneumoniae producing extended spectrum β lactamases （ESBLs） in 3 years were 63.34%, 54.80%,38.00%and 43.52%,35.30%,35.00%respectively. The resistance rate of staphylococcus and E. faecium and E. faecalis to glycopeptide antibiotic was less than 6% in 3 years. The drug susceptibility rate of enterobacteriaceae to carbapenems was higher, and the resistance rate was less than 20% , but showed an upward trend year by year. The non fermentative bacteria pseudomonas aeruginosa and acinetobacter baumannii presented high resistance rate to various antibiotics, and their resistance rates were between 20% 30% and 30% 45% respectively to carbapenems. The top two antibiotics in the list of DDDs were always cephalosporins and penicillins, the third were quinolones, nitroimidazole and macrolide antibiotics, respectively. Antimicrobial total DDDs decreased year by year and had a certain relationship between resistance of some bacteria and their antibiotic DDDs. Conclusion：We should strictly implement the Guiding Principles for Clinical application of antibacterial, strengthen the surveillance of bacterial resistan

关 键 词：抗菌药 用药频度 耐药分析 

分 类 号：R978.1[医药卫生—药品]