特殊抗菌药物管理制度实行前后肺炎克雷伯菌耐药率变化  

Changes in the antibiotic resistance rates of Klebsiella pneumoniae before and after the implementation of special antibacterial drug management system

作　　者：裴丽淑[1] 祁伟[2] 魏殿军[3] 于树云[1] 杨夏[1] 

机构地区：[1]天津医科大学第二医院呼吸科,天津300211 [2]天津医科大学第二医院感染科研究所,天津300211 [3]天津医科大学第二医院检验科,天津300211

出　　处：《中华医院感染学杂志》2015年第4期825-826,838,共3页Chinese Journal of Nosocomiology

基　　金：天津市卫生局基金资助项目(2012KZ080)

摘　　要：目的了解医院特殊抗菌药物管理制度实行前后,临床分离肺炎克雷伯菌的耐药性变化及常用抗菌药物用药频度变化。方法分析医院2011年1月-2012年12月临床分离1 166株肺炎克雷伯菌,在特殊抗菌药物管理制度实行前、后,对常用抗菌药物的耐药率变化,并对医院常用抗菌药物的用药频度(DDD)变化进行统计分析。结果特殊抗菌药物管理制度实行前肺炎克雷伯菌对氨曲南、头孢吡肟、头孢呋辛、头孢曲松、头孢他啶的耐药率较高,分别为44.7%、44.5%、47.2%、44.4%、44.4%,实行后耐药率分别为38.1%、38.3%、41.3%、38.1%、38.1%,而对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、阿米卡星的耐药率较低,分别为11.9%、12.7%、5.0%,实行后耐药率分别为11.7%、11.2%、4.4%,差异有统计学意义(P<0.05),未发现耐美罗培南和亚胺培南菌株;常用抗菌药物的DDD值显示,特殊抗菌药物管理实施后特殊抗菌药物中的头孢吡肟、美罗培南、亚胺培南/西司他丁用量均有所下降。结论肺炎克雷伯菌对抗菌药物的耐药结果为临床抗感染经验用药提供参考,特殊抗菌药物管理制度实施后的细菌耐药性变化为临床抗菌药物管理提供借鉴。OBJECTIVE To observe the changes in antibiotic resistance of clinical isolated Klebsiella pneumoniae and DDD before and after the implementation of special antibacterial drug management system.METHODS Totally1 166 strains of clinical isolated K.pneumoniaein the hospital from Jan.2011 to Dec.2012 were analyzed for the changes in antibiotic resistance before and after the implementation of special antibacterial drug management system,and the changes in commonly used antibiotic DDD were also statistically analyzed.RESULTS The resistance rates of K.pneumoniae to aztreonam,cefepime,cefuroxime,ceftriaxone,ceftazidime were high,being44.7%,44.5%,47.2%,44.4%,and 44.4%respectively before the implementation of special antibacterial drug management system,which were changed into 38.1%,38.3%,41.3%,38.1%,and 38.1% after the implementation.The resistance rates to cefoperazone/sulbactam,piperacillin/tazobactam and amikacin were low,being 11.9%,12.7%,and 5.0% respectively before the implementation and 11.7%,11.2%,and 4.4%respectively after the implementation,with significant difference（P0.05）.No strains resistant to meropenem and imipenem were found.The commonly used antibiotic DDD showed that after the implementation of special antibacterial drug management system the doses of cefepime,meropenem,imipenem were reduced.CONCLUSION The study on antibiotic resistance rates of K.pneumoniae can be used as a reference for the clinical medication.The changes in the resistance rate after the implementation of special antibacterial drug management system provide reference for clinical antibacterial management.

关 键 词：肺炎克雷伯菌 耐药率 抗菌药物 管理 用药频度 

分 类 号：R978.1[医药卫生—药品]