非致病菌对抗菌药物合理选用的影响  

Influence of Non-Pathogenic Bacteria on the Rational Selection of Antibiotics

作　　者：周义录 车美瑶 张鑫宇 杨海玲 ZHOU Yilu;CHE Meiyao;ZHANG Xinyu;YANG Hailing(The First People′s Hospital of Zigong,Zigong,Sichuan,China 643099;Sichuan Vocational College of Health and Rehabilitation,Zigong,Sichuan,China 643000)

机构地区：[1]四川省自贡市第一人民医院,四川自贡643099 [2]四川卫生康复职业学院,四川自贡643000

出　　处：《中国药业》2021年第22期122-124,共3页China Pharmaceuticals

基　　金：四川省自贡市重点科技计划项目[2020RKX04]。

摘　　要：目的为临床合理选用抗菌药物提供参考。方法统计医院2020年的232株常见多重耐药菌[含耐甲氧西林金黄色葡萄球菌(MRSA)、耐碳青霉烯类抗菌药物肠杆菌科细菌(CRE)、耐碳青霉烯类铜绿假单胞菌(CRPAE)、耐碳青霉烯类鲍曼不动杆菌(CRABA)]的药敏检测报告,以及药师到临床追踪干预的药物治疗记录,按报告发布时患者选用或未选用药敏检测报告中敏感药物治疗是否有效进行统计与分析。结果检查药敏检测报告时,选用敏感药物治疗无效及未选用敏感药物治疗有效的两类药敏检测报告结果,均可能由非致病菌(含污染菌与定植菌)所致(占总数的50.00%),其中MRSA 68例(58.62%)、CRABA 24例(20.69%)、CRE 20例(17.24%)、CRPAE 4例(3.44%),培养标本以分泌物、尿、痰较多,其中分泌物培养的MRSA非致病菌药敏报告最多,占同类菌的各类标本总数的68.75%。讨论非致病菌药敏报告影响临床合理用药。通过规范标本操作管理、识别非致病菌药敏报告、药师积极跟踪干预,可减少非致病菌对临床合理选用抗菌药物的影响。Objective To provide a reference for the clinical rational selection of antibiotics.Methods The drug sensitivity test reports of 232 strains of common multidrug-resistant bacteria[including methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacteriaceae(CRE),carbapenem-resistant Pseudomonas aeruginosa(CRPAE),carbapenem-resistant Acinetobacter baumannii(CRABA)]in our hospital in 2020,and the drug treatment records of pharmacists’clinical follow-up intervention were analyzed according to the four aspects of effective or ineffective drug treatment in the drug sensitivity test reports of patients with or without selection of sensitive drugs when the report was released.Results When examining the drug sensitivity test report,the results of the two kinds of drug sensitivity test reports(the treatment with sensitive drugs was ineffective and the treatment without sensitive drugs was effective)might be caused by non-pathogenic bacteria(including contaminated bacteria and colonized bacteria),which accounting for 50.00%of the total drug sensitivity test reports.Among them,there were 68 cases of MRSA(58.62%),24 cases of CRABA(20.69%),20 cases of CRE(17.24%)and four cases of CRPAE(3.44%).The cultured samples were mainly secretions,urine and sputum,and the drug sensitivity reports of non-pathogenic bacteria MRSA cultured in secretions were the most,accounting for 68.75%of the total specimens of similar bacteria.Conclusion The drug sensitivity report of non-pathogenic bacteria affects the clinical rational drug use.The influence of non-pathogenic bacteria on the rational selection of antibiotics can be reduced by standardizing the operation and management of specimens,identifying the drug sensitivity report of non-pathogenic bacteria,and pharmacists’active follow-up intervention.

关 键 词：多重耐药菌 非致病菌 药敏报告 定植菌 污染菌 抗菌药物 合理用药 

分 类 号：R969.3[医药卫生—药理学] R978.1[医药卫生—药学]