抗菌藥物管理策略的實(shí)施對(duì)我院綜合ICU常見(jiàn)致病菌耐藥性的影響
發(fā)布時(shí)間：2018-08-17 18:39
【摘要】：目的評(píng)估我院ICU中實(shí)施抗菌藥物管理策略的效果,包括對(duì)抗菌藥物使用情況及ICU常見(jiàn)致病菌耐藥性的評(píng)估。方法我院自2011年8月份前后開(kāi)始實(shí)施抗菌藥物管理策略,包括分級(jí)預(yù)授權(quán)、限制應(yīng)用、限制圍手術(shù)期應(yīng)用、總量控制。收集2010-2014年度病人的人口學(xué)和臨床數(shù)據(jù)、抗菌藥物使用強(qiáng)度、病人的初始抗菌藥物選擇、常見(jiàn)致病菌的耐藥率。利用統(tǒng)計(jì)學(xué)方法對(duì)采集數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析,達(dá)到評(píng)估持續(xù)實(shí)施抗菌藥物管理策略以來(lái),評(píng)估我院ICU抗菌藥物使用情況變化,評(píng)估對(duì)我院ICU常見(jiàn)的5種致病菌,包括大腸埃希菌,肺炎克雷白桿菌,銅綠假單胞菌,鮑曼不動(dòng)桿菌,金黃色葡萄球菌的耐藥性的影響。結(jié)果從2010年至2013年,入ICU前接受抗菌藥物治療的比例明顯下降,實(shí)施干預(yù)策略后,ICU總體抗菌藥物使用強(qiáng)度明顯下降,從2010年的163.46和2011年的190.01DDDs/100 patient-days下降為2012年的114.36和2013年的96.4DDDs/100 patient-days�？咕幬锸褂脴�(gòu)成顯示,2010-2013年4年期間,其他β內(nèi)酰胺類、氨基糖甙類、大環(huán)內(nèi)酯類、喹諾酮類及咪唑類抗菌藥物使用率明顯下降,有統(tǒng)計(jì)學(xué)意義(P0.05)。2010-2013年4年期間,我們所監(jiān)測(cè)的5種致病菌的耐藥性有較大范圍的改善。但是,2013年與2012年相比較,這5種致病菌的耐藥狀況改善并不廣泛。除了鮑曼不動(dòng)桿菌,只有大腸埃希菌對(duì)阿米卡星的耐藥率、銅綠假單胞菌對(duì)環(huán)丙沙星的耐藥率及金黃色葡萄球菌對(duì)苯唑西林的耐藥率的改善具有統(tǒng)計(jì)學(xué)意義。肺炎克雷白桿菌的耐藥沒(méi)有明顯改善,甚至出現(xiàn)肺炎克雷白桿菌對(duì)氨芐西林/舒巴坦的耐藥率明顯增加的情況。結(jié)論2010-2013年,.我院限制應(yīng)用為主的抗菌藥物管理實(shí)施后,ICU中抗菌藥物消耗明顯下降,使用構(gòu)成趨于合理,常見(jiàn)致病菌的耐藥性改善。但2013年耐藥性的改善有放緩甚至反彈的趨勢(shì),抗菌藥物管理的遠(yuǎn)期效果不明朗,可能通過(guò)抗菌藥物管理以期望達(dá)到抗菌藥物使用更為合理并延緩細(xì)菌耐藥性惡化的目標(biāo)更為現(xiàn)實(shí)�？咕幬锕芾淼呐R床效果需大范圍和長(zhǎng)時(shí)期的監(jiān)測(cè)和評(píng)估。
[Abstract]:Objective to evaluate the effect of antimicrobial management strategy in ICU, including the use of antimicrobial agents and drug resistance of common pathogens of ICU. Methods the management strategy of antimicrobial agents was implemented in our hospital from August to August 2011, including graded pre-authorization, limited application, perioperative application, and total control. Collect the demographic and clinical data of patients from 2010 to 2014, the intensity of antimicrobial use, the initial antibiotic selection of patients, and the drug resistance rate of common pathogenic bacteria. The statistical method was used to analyze the collected data, to evaluate the changes of the use of ICU antibiotics in our hospital since the continuous implementation of antimicrobial management strategy, and to evaluate the five common pathogens of ICU in our hospital, including Escherichia coli. Antibiotic resistance of Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus. Results from 2010 to 2013, the proportion of patients receiving antimicrobial therapy before entering ICU decreased significantly, and the overall intensity of antimicrobial use decreased significantly after the intervention strategy, from 163.46 and 2011 190.01DDDs/100 patient-days in 2010 to 114.36 and 96.4DDDs/100 patient-days in 2012. The composition of antimicrobial use showed that the use of other 尾 -lactams, aminoglycosides, macrolides, quinolones and imidazoles decreased significantly during the 4-year period 2010-2013 (P0.05). The drug resistance of the five pathogens we monitored improved to a large extent. However, the resistance of these five pathogens was not widely improved in 2013 compared with 2012. Except for Acinetobacter baumannii, only Escherichia coli resistance to amikacin, Pseudomonas aeruginosa to ciprofloxacin and Staphylococcus aureus to oxacillin were significantly improved. The resistance of Klebsiella pneumoniae to ampicillin / sulbactam did not improve significantly, and the resistance rate of Klebsiella pneumoniae to ampicillin / sulbactam increased significantly. Conclusion from 2010 to 2013. After the limited use of antimicrobial agents was implemented in ICU, the consumption of antibiotics decreased significantly, the composition of use tended to be reasonable, and the drug resistance of common pathogenic bacteria was improved. But the improvement in drug resistance in 2013 has slowed or even rebounded, and the long-term effects of antimicrobial management are unclear. It is possible to achieve more rational use of antimicrobial agents and delay the deterioration of bacterial drug resistance through antimicrobial management. The clinical effect of antimicrobial drug management needs to be monitored and evaluated in a wide range and long-term.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R446.5
本文編號(hào)：2188543
[Abstract]:Objective to evaluate the effect of antimicrobial management strategy in ICU, including the use of antimicrobial agents and drug resistance of common pathogens of ICU. Methods the management strategy of antimicrobial agents was implemented in our hospital from August to August 2011, including graded pre-authorization, limited application, perioperative application, and total control. Collect the demographic and clinical data of patients from 2010 to 2014, the intensity of antimicrobial use, the initial antibiotic selection of patients, and the drug resistance rate of common pathogenic bacteria. The statistical method was used to analyze the collected data, to evaluate the changes of the use of ICU antibiotics in our hospital since the continuous implementation of antimicrobial management strategy, and to evaluate the five common pathogens of ICU in our hospital, including Escherichia coli. Antibiotic resistance of Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus. Results from 2010 to 2013, the proportion of patients receiving antimicrobial therapy before entering ICU decreased significantly, and the overall intensity of antimicrobial use decreased significantly after the intervention strategy, from 163.46 and 2011 190.01DDDs/100 patient-days in 2010 to 114.36 and 96.4DDDs/100 patient-days in 2012. The composition of antimicrobial use showed that the use of other 尾 -lactams, aminoglycosides, macrolides, quinolones and imidazoles decreased significantly during the 4-year period 2010-2013 (P0.05). The drug resistance of the five pathogens we monitored improved to a large extent. However, the resistance of these five pathogens was not widely improved in 2013 compared with 2012. Except for Acinetobacter baumannii, only Escherichia coli resistance to amikacin, Pseudomonas aeruginosa to ciprofloxacin and Staphylococcus aureus to oxacillin were significantly improved. The resistance of Klebsiella pneumoniae to ampicillin / sulbactam did not improve significantly, and the resistance rate of Klebsiella pneumoniae to ampicillin / sulbactam increased significantly. Conclusion from 2010 to 2013. After the limited use of antimicrobial agents was implemented in ICU, the consumption of antibiotics decreased significantly, the composition of use tended to be reasonable, and the drug resistance of common pathogenic bacteria was improved. But the improvement in drug resistance in 2013 has slowed or even rebounded, and the long-term effects of antimicrobial management are unclear. It is possible to achieve more rational use of antimicrobial agents and delay the deterioration of bacterial drug resistance through antimicrobial management. The clinical effect of antimicrobial drug management needs to be monitored and evaluated in a wide range and long-term.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R446.5
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