本文選題：病原菌 + 抗菌藥物�。� 參考：《中國感染控制雜志》2017年08期

【摘要】：目的了解2011—2015年抗菌藥物專項整治前后常見病原菌分布及耐藥性變遷,為指導抗菌藥物臨床應用提供依據。方法收集2011—2015年某院住院患者抗菌藥物使用情況及患者分離病原菌,分析主要病原菌對常見抗菌藥物的耐藥率變化趨勢。結果2011—2015年住院患者抗菌藥物使用率從75.84%下降至37.35%,抗菌藥物使用強度從59.53/(100例患者·d)下降至33.63/(100例患者·d),均呈下降趨勢(均P0.05)。共分離病原菌10 091株,其中革蘭陽性菌2 338株,占23.17%;革蘭陰性菌7 110株,占70.46%;真菌643株,占6.37%。居前5位的病原菌為大腸埃希菌(20.85%)、肺炎克雷伯菌(15.90%)、銅綠假單胞菌(11.70%)、金黃色葡萄球菌(7.35%)和鮑曼不動桿菌(6.82%)。主要病原菌對常用抗菌藥物耐藥率呈下降趨勢,其中大腸埃希菌和肺炎克雷伯菌對哌拉西林/他唑巴坦、頭孢西丁、阿米卡星的耐藥率下降最明顯(2015年均4%);銅綠假單胞菌較鮑曼不動桿菌對常用抗菌藥物的敏感性整體較高,對哌拉西林/他唑巴坦、頭孢哌酮/舒巴坦、頭孢他啶、頭孢吡肟、阿米卡星、環(huán)丙沙星耐藥率下降明顯,對上述藥物的耐藥率20%,對碳青霉烯類抗生素的耐藥率高于其他常用藥物;鮑曼不動桿菌對阿米卡星、左氧氟沙星耐藥率下降最明顯,但對美羅培南、亞胺培南耐藥率明顯上升,至2015年,耐藥率均50%。金黃色葡萄球菌對氟喹諾酮類藥物耐藥率下降最明顯(2%),未見耐萬古霉素菌株。結論常見病原菌的耐藥率隨著抗菌藥物專項整治后抗菌藥物使用量的下降均有不同程度的下降,抗菌藥物合理使用與延緩細菌耐藥可能有關。
[Abstract]:Objective to investigate the distribution of common pathogens and the changes of drug resistance before and after the special treatment of antimicrobial agents from 2011 to 2015, so as to provide the basis for guiding the clinical application of antimicrobial agents. Methods the use of antimicrobial agents and the isolation of pathogens from inpatients in a hospital from 2011 to 2015 were collected and the trend of resistance of main pathogens to common antimicrobial agents was analyzed. Results from 2011 to 2015, the utilization rate of antibiotics decreased from 75.84% to 37.35%, and the intensity of antimicrobial use decreased from 59.53 / (100 patients d) to 33.63 / 100 cases (all P0.05). A total of 10 091 strains of pathogenic bacteria were isolated, of which 2 338 were Gram-positive bacteria (23.17%), 7 110 were Gram-negative bacteria (70.46) and 643 were fungi (6.37%). The top 5 pathogens were Escherichia coli (20.85%), Klebsiella pneumoniae (15.90%), Pseudomonas aeruginosa (11.70%), Staphylococcus aureus (7.35%) and Acinetobacter baumannii (6.82%). The resistance rate of major pathogens to common antimicrobial agents showed a decreasing trend, in which Escherichia coli and Klebsiella pneumoniae were resistant to piperacillin / tazobactam, cefoxitin, and other bacteria. The resistance rate of amikacin was the most obvious (4% in 2015), Pseudomonas aeruginosa was more sensitive to common antibiotics than Acinetobacter baumannii, and was more sensitive to piperacillin / tazobactam, cefoperazone / sulbactam, ceftazidime, cefepime, ceftazidime and cefepime. The resistance rate of amikacin and ciprofloxacin to ciprofloxacin decreased significantly, the resistance rate to carbapenem antibiotics was higher than that to carbapenem antibiotics, and the resistance rate of Acinetobacter baumannii to amikacin and levofloxacin was the most obvious. But the rates of resistance to meropenem and imipenem increased significantly, and by 2015, the drug resistance rates were 50%. The resistance rate of Staphylococcus aureus to fluoroquinolones was the most obvious (2%), but no vancomycin resistant strain was found. Conclusion the drug resistance rate of common pathogens decreased with the decrease of antimicrobial use after special treatment of antimicrobial agents. Rational use of antimicrobial agents may be related to delaying the drug resistance of bacteria.
【作者單位】： 東營市人民醫(yī)院;
【分類號】：R446.5

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