2017~2021年天津医院抗菌药物使用强度与分离菌耐药性变化情况  

Changes in intensity of antibiotics use and drug resistance of isolated bacteria in Tianjin Hospital from 2017 to 2021

作　　者：郎磊[1] 杨雅琼[2] LANG Lei;YANG Ya-qiong(Department of Infection Management,Tianjin Hospital,Tianjin 300211,China;不详)

机构地区：[1]天津医院感染管理科,天津300211 [2]天津医院检验科,天津300211

出　　处：《中国处方药》2023年第9期73-78,共6页Journal of China Prescription Drug

摘　　要：目的分析天津医院2017~2021年抗菌药物使用强度与分离菌耐药性变化情况,为指导抗菌药物临床合理应用提供依据。方法收集2017~2021年天津医院住院患者常见抗菌药物的使用情况及分离菌,分析主要分离菌对常见抗菌药物的耐药率变化趋势。结果2017~2021年天津医院住院患者抗菌药物使用率呈现下降趋势,常用抗菌药物使用率从13.48%下降为9.89%,且2021年住院患者最多的情况下,抗菌药物使用率最低。5年共分离菌株18207株;来源主要为伤口分泌物、痰液、血液、尿液,分别占29.88%、23.67%、9.74%和9.08%。分离菌种类包括革兰阳性菌6086株(33.43%),革兰阴性菌11150株(61.24%),真菌971株(5.33%)。主要菌种为肺炎克雷伯菌(13.92%),金黄色葡萄球菌(13.16%),铜绿假单胞菌(9.51%),鲍曼不动杆菌(9.27%),大肠埃希菌(9.01%)。药敏试验结果显示,不同致病菌对常用抗菌药物敏感性不同,如金黄色葡萄球菌对克林霉素等常用抗菌药物耐药率明显下降;而肺炎克雷伯菌对大多数常用抗菌药(复方新诺明、庆大霉素和米诺环素除外)的耐药率逐年上升。结论天津医院细菌耐药监测数据与全国细菌耐药监测网的统计数据有一定的差异,完全依赖后者进行经验性抗感染治疗可能存在较大问题。不同医院应根据医院的细菌种类分布及耐药情况来指导临床合理用药。Objective To analysis the distribution of common isolates in hospitalized patients and changes in drug resistance rates in Tianjin Hospital from 2017 to 2021,to provide a basis for guiding clinical application of antibacterial drugs.Methods The usage of common antibiotics and isolates of inpatients in Tianjin Hospital from 2017 to 2021 was collected,and the trend of resistance rate of main isolates to common antimicrobials was analyzed.Results From 2017 to 2021,the utilization rate of antibiotics among inpatients in Tianjin Hospital showed a downward trend.The use rate of commonly used antimicrobials decreased from 13.48%to 9.89%,and the use rate of antimicrobials was the lowest in 2021 when the largest number of hospitalized patients was achieved.A total of 18207 strains were isolated in 5 years;the main sources were wound secretions,sputum,blood,and urine,accounting for 29.88%,23.67%,9.74%and 9.08%,respectively.The isolates included 6,086 strains(33.43%)of gram-positive bacteria,11150 strains(61.24%)of gram-negative bacteria,and 971 strains(5.33%)of fungi.The main bacterial species were Klebsiella Pneumoniae(13.92%),Staphylococcus aureus(13.16%),Pseudomonas aeruginosa(9.51%),Acinetobacter baumanii(9.27%),Escherichia coli(9.01%).The results of the susceptibility test showed that different pathogenic bacteria had different sensitivities to commonly used antibacterial drugs.For example,the resistance rate of Staphylococcus aureus to commonly used antibacterial drugs such as clindamycin decreased significantly;the resistance rate of Klebsiella Pneumoniae to most commonly used antimicrobials(with the exception of co-trimoxazole,gentamicin,and minocycline)is increasing year by year.Conclusion There is a certain difference between the bacterial drug resistance monitoring data in Tianjin Hospital and the national bacterial drug resistance monitoring network statistics,and there may be major problems in relying solely on the latter for empirical anti-infective treatment.Different hospitals should guide clinical rational

关 键 词：抗菌药物 分离菌 耐药率 使用强度 伤口分泌物 

分 类 号：R446.5[医药卫生—诊断学]