我院肾脏内科2011-2013年病原菌耐药性监测分析及治疗方案优化策略  

Monitoring and Analysis of Bacterial Resistance in Nephrology Department of Our Hospital and Strategy of Dosage Regimen Optimization during 2011-2013

作　　者：钱卿[1] 张全英[1] 王玉月[1] 钱春艳[1] 陈荣[1] 

机构地区：[1]苏州大学附属第三医院,江苏常州213003

出　　处：《中国药房》2015年第2期204-207,共4页China Pharmacy

基　　金：常州市科技局指导性计划项目(No.CY20119017)

摘　　要：目的:了解肾脏内科住院患者感染致病菌的分布特点及耐药现状和变迁,探讨群体药动-药效学研究对预防耐药菌产生的意义。方法:采用WHONET 5.4软件回顾性统计并分析我院肾脏内科2011-2013年各类送检标本的病原菌培养结果及药敏试验数据,按美国临床实验室标准化协会(CLSI)的规则进行药敏结果判定。结果:共分离出1 230株感染致病菌,革兰阴性菌以大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌为主,检出率分别为46.50%、7.07%、4.15%,对阿米卡星、哌拉西林/他唑巴坦、碳青霉烯类保持低耐药水平,耐药率均小于23.53%,其中大肠埃希菌对以上3种抗菌药物的平均耐药率分别为4.61%、3.84%、0.41%;革兰阳性菌以金黄色葡萄球菌、肠球菌属和表皮葡萄球菌为主,检出率分别为9.43%、5.20%、3.90%,均对糖肽类药物高度敏感,其中金黄色葡萄球菌对利福平、四环素的耐药率均小于12.50%,对庆大霉素、环丙沙星和苯唑西林的平均耐药率分别为12.28%、15.18%、25.00%。结论:在肾脏内科,革兰阴性菌主要引起泌尿系感染,对氨基糖苷类、β-内酰胺酶抑制剂类、碳青霉烯类敏感性高;革兰阳性菌可引起血流感染、腹膜感染及尿路感染,对糖肽类药物敏感。开展群体药动-药效学研究优化改进治疗方案,对提高治疗效果、减少细菌耐药意义重大。OBJECTIVE： To investigate the distribution and drug resistance variation of pathogenic bacteria in nephrology de- partment and the significance of the PPK-PD research. METHODS： Retrospective statistical method was performed to analyze the data of bacteria culture and drug resistance in nephrology department of our hospital from 2011 to 2013 through the WHONET5.4 software. Assessment criteria of the drug susceptibility test referred to the CLSI rules. RESULTS： 1 230 strains of pathogens were isolated in three years. Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumonia were the top three among the Gram-negative bacteria and the detection rates were 46.50%, 7.07% and 4.15%, respectively. The drug resistance rates of the three bacteria to amikacin, piperacillin/tazobactam and carbapenems were lower than 23.53%, and the average drug resistance rates of E. coli were 4.61%, 3.84% and 0.41%, respectively. The main Gram-positive bacteria were Staphylococcus aureus, Enterococ- cus and Staphylococcus epidermidis, of which the detection rates were 9.43%, 5.20% and 3.90%. They all showed high sensitivity to glycopeptides. The drug resistance rates of S. aureus to rifampicin and tetracycline were lower than 12.50%, and the average drug resistance rates to gentamicin, ciprofloxacin and oxacillin were 12.28% , 15.18% and 25.00% , respectively. CONCLU- SIONS： Gram-negative bacteria which are mostly from urine specimens were highly sensitive to aminoglycosides, fl-lactamase in- hibitor and carbapenems; Gram-positive bacteria can cause bloodstream infection, peritoneal infection and urinary tract infection. Glycopeptides are the most effective drug. Meanwhile, it is of great significance to design the optimal dosage regimen based on the PPK-PD research for the improvement of therapeutic efficacy and the reduction of bacterial resistance.

关 键 词：肾脏内科 耐药性监测 群体药动-药效学 

分 类 号：R378.2[医药卫生—病原生物学] R446.5[医药卫生—基础医学]