大理市乡镇卫生院抗菌药物使用现况和细菌耐药监测分析  

Surveillance and analysis of bacterial resistance and current use of antimicrobial agents in township health center of dali city

作　　者：林意菊 迟锦瑜 李柳琴 李慧 段素英 杨蓉 杨英 LIN Yiju;CHI Jinyu;LI Liuqin;LI Hui;DUAN Suying;YANG Rong;YANG Ying(Dali first people’s hospital,Dali 671000,China;不详)

机构地区：[1]大理市第一人民医院,云南大理671000

出　　处：《现代医院》2020年第9期1361-1365,共5页Modern Hospitals

摘　　要：目的调查大理市乡镇卫生院抗菌药物使用现况,了解病原菌分布,为下一步抗菌药物的管理和经验治疗提供循证依据。方法用分层抽样方法确定9家卫生院及下属21家卫生室的抽取样本量。抽取相应样本单位的使用抗菌药物的处方100张和病历30份,对诊断进行分类汇总,并对处方和病历进行点评,得出抗菌药物使用的现况;到卫生院进行标本采集,并对所采集标本进行病原学检测和药敏试验,针对各抽样单位培养出的细菌及耐药现状进行分析。结果9家乡镇卫生院的抗菌药物使用不合理率为91.4%,联合用药率为39.6%,其中一联、二联、三联及以上用药分别占60.4%、35.6%、4.0%;不合理处方数占比75.63%;痰液标本的平均合格率为27.93%,痰培养共有35例呈阳性,占比10.51%。结论大理市9所乡镇卫生院普遍存在过度使用抗菌药物的现象,具体为:抗菌药物使用率偏高,使用强度、联合用药率及不合理处方出现率均较高。目前,痰培养结果虽然显示以敏感菌为主,但抗菌药物的不合理使用,会诱导细菌耐药。Objective To investigate the current situation of antimicrobial use in township health centers in Dali city and realize the distribution of pathogenic bacteria,so as to provide evidence-based basis for the management of antimicrobial agents and empiric therapy in the next step.Methods The sample sizes of 9 hospitals and 21 subordinate clinics were determined by stratified sampling method.To collect 100 prescriptions and 30 medical records of antibiotics used in the corresponding sample units,classify and summarize the diagnosis,comment on the prescriptions and medical records,and get the current situation of antibiotics use;to collect specimens in hospitals,and to carry out pathogenic detection and drug susceptibility test for the collected specimens,and to cultivate the samples for each sampling unit.The present situation of bacteria and drug resistance was analyzed.Results The irrational rate of antimicrobial drug use in 9 township hospitals was 91.4%.The combined drug use rate was 39.6%,including one,two and three.The combined use of antimicrobial drugs accounted for 60.4%,35.6%and 4.0%;Proportion of unreasonable prescriptions was 75.63%;The average qualified rate of sputum specimens was 27.93%.35 sputum cultures were positive,accounting for 10.51%.Conclusion Overuse of antibiotics is common in 9 township hospitals in Dali City,which includes high utilization rate of antibiotics,high use intensity,combined use rate and unreasonable prescriptions.At present,although sputum culture results show that sensitive bacteria are dominant,the irrational use of antibiotics will induce bacterial resistance.

关 键 词：乡镇卫生院 抗菌药物 细菌耐药分析 合理用药 

分 类 号：R969.3[医药卫生—药理学]