陕西省247所医院抗菌药物使用与病原学送检分析  

Use of antibiotics and etiological submission in 247 hospitals in Shaanxi province

作　　者：索瑶[1] 李源 李颖[3] 范珊红[3] 

机构地区：[1]西安交通大学第二附属医院感染管理科,陕西西安710004 [2]陕西省卫生和计划生育委员会医政医管局,陕西西安710003 [3]第四军医大学唐都医院疾病预防控制科,陕西西安710038

出　　处：《中华医院感染学杂志》2016年第11期2462-2464,2537,共4页Chinese Journal of Nosocomiology

基　　金：陕西省攻关计划基金资助项目(2012K18-01-05)

摘　　要：目的调查2015年陕西省各医院住院患者抗菌药物使用、病原学送检及耐药菌的检出,为进一步规范抗菌药物使用提供理论依据。方法采用电子函调方式,对2015年1-12月陕西省247所二级以上医院出院患者抗菌药物使用、病原学送检及耐药菌的检出进行回顾性问卷调查,数据采用SPSS17.0统计软件进行分析。结果下发调查问卷248份,回收有效问卷247份,实查率99.6%;出院患者抗菌药物使用率为53.3%;标本送检率为39.9%,其中血液培养和痰液培养标本送检率分别为17.7%和45.0%;共检出14 226株多药耐药菌,痰液标本中检出9 690株占68.1%,血液标本中检出595株占4.2%;多药耐药菌的耐药率由高到低依次为耐碳青霉烯类鲍氏不动杆菌、耐甲氧西林金黄色葡萄球菌、耐碳青霉烯类铜绿假单胞菌、耐碳青霉烯类肺炎克雷伯菌、耐碳青霉烯类肠杆菌及耐万古霉素肠球菌,分别占46.8%、39.5%、22.5%、4.7%、4.4%及2.4%。结论临床常见的6种耐药菌大部分来自痰液,临床很难判断是否为定植或污染;应进一步加强抗菌药物规范管理,规范采样及送检要求,切实达到以标本培养指导抗菌药物使用,减少细菌耐药的目的。OBJECTIVE To investigate the utilization rates of antibiotics,etiological submission rates,and isolation rates of drug-resistant bacteria of hospitalized patients in Shaanxi province in 2015 so as to provide theoretical basis for reasonable use of antibiotics.METHODS By means of electronic questionnaire,the retrospective questionnaire survey was conducted for the utilization rates of antibiotics,etiological submission rates,and isolation rates of drug-resistant bacteria of the hospitalized patients in 247 tertiary hospitals from Jan 2015 to Dec 2015.The statistical analysis of data was performed with the use of SPSS17.0software.RESULTS A total of 248 questionnaires were issued,and 247 valid were collected,with the actual investigation rate 99.6%.The utilization rate of antibiotics of the discharged patients was 53.3%.The submission rate of specimens was 39.9%;the submission rate of blood specimens was 17.7%,and the submission rate of sputum specimens was 45.0%.Totally 14 226 strains of multidrug-resistant organisms were isolated,of which 9 690（68.1%）were isolated from the sputum specimens,and 595（4.2%）strains were isolated from the blood specimens.The drug resistance rates of the multidrug-resistant organisms,in descending order,were as follows：46.8%（carbapenem-resistant Acinetobacter baumannii）,39.5%（methicillin-resistant Staphylococcus aureus）,22.5%（carbapenem-resistant Pseudomonas aeruginosa）,4.7%（carbapenem-resistant Klebsiella pneumoniae）,4.4%（carbapenem-resistant Enterobacter）,2.4%（vancomycin-resistant Enterococcus）.CONCLUSION The sputum specimens are the major specimen source from which the 6common species of drug-resistant bacteria are isolated,and the colonization or contamination is difficult to be identified in the hospital.It is necessary to further strengthen the standardized management of antibrotics and standardize the requirements of sampling and submission so as to guide the use of antibiotics on the basis of specimens culture and reduce the drug-resistant bacter

关 键 词：抗菌药物 使用 标本送检 痰液 血液 培养 耐药菌 

分 类 号：R181.3[医药卫生—流行病学]