急诊细菌感染患者病原学及抗菌药物应用特点  

Etiological characteristics of bacterial infections in emergency department and use of antibiotics

作　　者：赵微 卞雯 胡怡倩 邹丽婷 路幸 ZHAO Wei;BIAN Wen;HU Yi-qian;ZOU Li-ting;LU Xing(Affiliated Hospital of Jiangnan University,Wuxi,Jiangsu 214000,China)

机构地区：[1]江南大学附属医院急诊科,江苏无锡214000

出　　处：《中华医院感染学杂志》2021年第10期1507-1511,共5页Chinese Journal of Nosocomiology

基　　金：无锡市医院管理中心科研基金资助项目(YGZXM14027)。

摘　　要：目的分析急诊科抗菌药物使用情况、病原菌分布特点及细菌学培养结果.方法选取2017年3月-2020年3月江南大学附属医院急诊科接诊的使用抗菌药物且有明确病原菌培养结果的成年患者100例为研究对象,分析其疾病类型、抗菌药物使用情况,对检出的病原菌分布与药敏结果进行分析.结果100例患者年龄20~60岁占65.00%,疾病类型主要为呼吸系统、消化系统疾病,分别占64.00%、23.00%;抗菌药物以头孢菌素类、青霉素类使用率较高,其中使用居前四位的药物为注射用头孢噻肟钠、注射用阿奇霉素、左氧氟沙星注射液、注射用头孢硫脒;分离的病原菌主要为大肠埃希菌占21.00%、鲍氏不动杆菌占16.00%、肺炎克雷伯菌占13.00%、金黄色葡萄球菌占11.00%、肺炎链球菌占9.00%,且细菌培养阳性标本中痰液来源标本最多,占50.52%,其次为血液、尿液,分别占比22.69%、12.37%;大肠埃希菌对哌拉西林、左氧氟沙星、环丙沙星、庆大霉素、氨苄西林的耐药率均>55%,鲍氏不动杆菌对头孢哌酮/舒巴坦、阿米卡星的耐药率均<20%,对其他抗菌药物耐药率均>55%,肺炎克雷伯菌对所监测药物耐药率均<40%,未发现耐万古霉素的金黄色葡萄球菌,肺炎链球菌对环丙沙星、红霉素、苯唑西林、青霉素G耐药率均>60%.结论江南大学附属医院急诊科抗菌药物使用集中在20~60岁患有呼吸系统、消化系统疾病的人群,且头孢菌素类、青霉素类抗菌药物使用率较高,分离的病原菌主要为大肠埃希菌、鲍氏不动杆菌、肺炎克雷伯菌,均对所监测的药物普遍耐药,应引起临床及相关部门重视.OBJECTIVE To investigate the status of use of antibiotics,distribution of pathogens and result of bacteriologic culture in emergency department.METHODS A total of 100 adult patients with history of use of antibiotics and definite result of etiological culture who were treated in the emergency department of Affiliated Hospital of Jiangnan University from Mar 2017 to Mar 2020 were recruited as the study subjects.The types of diseases and status of use of antibiotics were analyzed,and the distribution of isolated pathogens and result of drug susceptibility testing were observed.RESULTS Totally 100 patients were between 20 and 60 years old,accounting for 65.00%;the patients with respiratory system diseases accounted for 64.00%,the patients with digestive system diseases 23.00%.The utilization rates of cephalosporins and penicillin were high;cefotaxime sodium injection,azithromycin injection,levofloxacin injection and cefathiamidine injection ranked the top 4 used antibiotics.Among the major species of pathogens isolated,Escherichia coli accounted for 21.00%,Acinetobacter baummanni 16.00%,Klebsiella pneumoniae 13.00%,Staphylococcus aureus 11.00%,Streptococcus pneumoniae 9.00%.Among the specimens sources that were positive for bacterial culture,sputum specimens accounted for 50.52%,blood specimens 22.69%,urine specimens 12.37%.The drug resistance rates of the E.coli strains to piperacillin,levofloxacin,ciprofloxacin,gentamicin and ampicillin were more than 55%;the drug resistance rates of the A.baumannii strains to cefoperazone-sulbactam and amikacin were less than 20%,and the drug resistance rates to other antibiotics were more than 55%;the drug resistance rates of the K.pneumoniae strains to the antibiotics were less than 40%;no vancomycin-resistant S.aureus strains were found;the drug resistance rates of the S.pneumoniae strains to ciprofloxacin,erythromycin,oxacillin and penicillin G were more than 60%.CONCLUSION The population with respiratory system and digestive system diseases and aged between 20 and 60 years o

关 键 词：急诊科 抗菌药物 病原菌 细菌学培养 

分 类 号：R378[医药卫生—病原生物学]