重症监护病房抗菌药物使用和病原检测调查分析  

Survey on antibiotic use and pathogens in intensive care units during 2013

作　　者：吴丹梅[1,2] 李雷清[3] 吴振波[1] 王红英[1] 严继承[1] 王选锭[1] 

机构地区：[1]浙江大学医学院附属第二医院感染管理科,杭州310009 [2]福建省南平市第二医院 [3]浙江大学医学院附属第二医院重症医学科,杭州310009

出　　处：《中国感染与化疗杂志》2015年第6期533-537,共5页Chinese Journal of Infection and Chemotherapy

基　　金：国家卫生计生委科研基金省部共建项目(201462816)

摘　　要：目的分析重症监护病房(ICU)患者抗菌药物临床应用和病原检测情况,为促进合理用药和管理决策提供依据。方法回顾性调查2013年7-12月从浙江大学医学院附属第二医院ICU直接出院的所有病例,对患者入住ICU后感染情况、入住3 d内及整个住院期间抗菌药物使用以及病原学检查结果等进行分析。结果出院患者466例,整个住院期间有424例使用抗菌药物(91.0%),每例平均使用抗菌药物(2.95±2.02)种,平均使用时间为18.3 d;联合用药率53.3%,70.3%患者使用了特殊使用级广谱抗菌药物,94.3%使用了超广谱抗革兰阴性杆菌抗菌药物,酶抑制剂复合物、碳青霉烯类和专性抗革兰阳性球菌药物的使用率分别为66.5%、58.5%和54.7%。250例患者在入住ICU时有明确感染证据,初始抗菌药物联合使用率、超广谱抗革兰阴性杆菌药和特殊使用级广谱抗菌药物的使用率分别为36.0%、86.0%和55.6%;入住ICU时仅7.6%已有病原微生物检测结果,203例入住ICU3 d内作病原微生物检测,但仅59例(29.1%)是在首剂抗菌药物使用前采样。首次送检标本临床分离菌株以多重耐药革兰阴性杆菌和口咽部污染菌为主。结论入住ICU患者使用抗菌药物前后病原学证据缺少,随意使用超广谱抗革兰阴性杆菌药、特殊使用级抗菌药物以及联合用药现象很普遍,亟待临床医师转变用药理念,加强抗菌药物合理使用的管理。Objective To investigate the overall antibiotic use and pathogens in intensive care units（ICU）in order to provide evidence for rational use of antibiotics.Methods All the patients discharged from ICU during the period from July 1 to December 31,2013 were retrospectively reviewed for their clinical data,including infection,overall antibiotic use and first three day antibiotic use,and the pathogens isolated.Results A total of 466 patients were included in this analysis.During ICU stay,91.0%（424/466）of the patients received antibiotics.On average,every patient used（2.95±2.02）antibiotics for a duration of 18.3 days.Overall,53.3% of the patients received combination antimicrobial therapy,70.3% of the patients received special or broad-spectrum antimicrobial agents,94.3% of the patients were treated with extended broad-spectrum antibiotics against gram-negative bacilli.In addition,broad-spectrumβ-lactams/β-lactamase inhibitors,carbapenems and antigram positive agents were used in66.5%,58.5% and 54.7% of the patients,respectively.Infection was confirmed in250 patients when the patients were admitted to ICU.Combination antimicrobial therapy,extended broad-spectrum antibiotics against gram-negative bacilli and special broad-spectrum antibiotics were used empirically in 36.0%,86.0% and 55.6% of these infections,respectively.Pathogen was isolated from only 7.6% of these patients before initial antimicrobial therapy.Samples were taken in the first three days after ICU admission in 203 cases,of which only 59（29.1%）were sampled before the first dose of antimicrobial therapy in ICU.The isolates from the first specimens were prominently multidrugresistant gram negative bacilli and oropharyngeal flora.Conclusions Evidence is usually lacking for the infections in ICU patients before and after initial antimicrobial therapy.Extended broad-spectrum anti-gram negative antibiotics,special antibiotics and combination antimicrobial therapy are usually used nonspecifically.It is necessary for clinicians to change their

关 键 词：重症监护病房 广谱抗菌药物 细菌感染 病原检测 初始治疗 

分 类 号：R446.5[医药卫生—诊断学]