抗菌药物的管理与病原菌耐药性分析  

Relationship of antimicrobial application and pathogenic bacteria resistance

作　　者：陈芳[1] 沈定玉[2] 李新芳[3] 

机构地区：[1] 南京医科大学附属苏州医院药剂科 [2] 南京医科大学附属苏州医院护理部 [3]南京医科大学附属苏州医院感染管理科,江苏苏州215001

出　　处：《中华医院感染学杂志》2014年第18期4457-4459,共3页Chinese Journal of Nosocomiology

基　　金：苏州市科技计划基金资助项目(SYSD2012173)

摘　　要：目的了解医院主要流行菌株的变迁及抗菌药物使用与病原菌耐药之间的关系,为临床合理使用抗菌药物提供依据。方法对2011-2012年住院患者抗菌药物使用种类、使用强度、主要流行菌株的检出及耐药率进行统计分析,按照《全国临床检验操作规程》进行病原菌培养、分离及鉴定,药敏试验采用K-B纸片扩散法,试验操作与结果判读按CLSI标准进行,数据使用SPSS 11.5软件进行统计分析。结果医院住院患者抗菌药物使用品种从2011年的63种下降至2012年的48种,抗菌药物使用强度(AUD值)从2011年的72.26下降至55.92;主要流行菌株仍为白色假丝酵母菌、铜绿假单胞菌、鲍氏不动杆菌、嗜麦芽寡养单胞菌、肺炎克雷伯菌和大肠埃希菌等;白色假丝酵母菌检出率从21.76%降至18.55%,提示二重感染明显减少;铜绿假单胞菌、鲍氏不动杆菌的耐药率略有下降,总耐药率分别从67.39%、87.01%降至66.47%、82.13%,嗜麦芽寡养单胞菌耐药率有所上升,从69.57%升至75.85%;肺炎克雷伯菌和大肠埃希菌的耐药率显著下降,分别从38.10%、47.93%降至31.74%、41.28%。结论抗菌药物使用强度减弱,可以延缓病原菌耐药的发展,并可恢复部分病原菌对抗菌药物的敏感性。OBJECTIVE To investigate the relationship between antibiotic use and pathogenic bacteria resistance and understand changes in major prevailing strains so as to provide the reference for reasonable use of antibiotics . METHODS From 2011 to 2012 ,antibiotic varieties ,antibiotics use density （AUD） ,and detection and resistance rate of major prevailing strains were statistically analyzed respectively .The pathogenic bacteria was cultivated , isolated and identified according to National Clinical Laboratory Procedures .K-B disk diffusion method was taken for susceptibility test .Test procedure and result interpretation were performed in accordance with CLSI standard . The data was statistically analyzed by SPSS 11 .5 software .RESULTS Antibiotic varieties decreased from 63 cate-gories in 2011 to 48 categories in 2012 and antibiotic use density also decreased from 72 .26 to 55 .92 .The major prevailing strains were still Candida albicans ,Pseudomonas aeruginosa ,Acinetobacter baumannii ,Stenotroph-omonas maltophilia ,Klebsiella pneumonia ,and Escherichia coli .The detection rate of C .albicans decreased from 21 .76% to 18 .55% ,indicating the reduction of dual infection .The resistant rate of P .aeruginosa and A . baumannii fell slightly from 67 .39% ,87 .01% to 66 .47% ,82 .13% .And however ,that of S .maltophilia showed increased trend from 69 .57% to 75 .85% .The resistant rate of K .pneumonia and E .coli decreased significantly from 38 .10% ,47 .93% to 31 .74% ,41 .28% respectively .CONCLUSION The decrease in antibiotics use density can delay the development of some bacteria resistance and restore the sensitivity of some pathogenic bacteria to antibiotics .

关 键 词：抗菌药物 使用强度 病原菌 耐药性 合理用药 

分 类 号：R978.1[医药卫生—药品]