發(fā)布時間：2018-04-01 13:19

  本文選題：耐藥性　切入點：分布　出處：《華中科技大學(xué)》2007年碩士論文

【摘要】： 目的: 細菌耐藥問題已成為全球危機,為遏制細菌耐藥,我國不少專家和學(xué)者都開展了對細菌耐藥的研究,這些研究大多是從微觀的角度、從細菌耐藥本身開展的探索,從宏觀角度研究的很少。本研究旨在從宏觀管理的角度,用流行病學(xué)的思路和方法,研究我國細菌耐藥性在時間、空間、抗菌藥間的“三間”分布情況,為細菌耐藥研究者提供新的研究思路,促進細菌耐藥研究的全面性,并預(yù)測細菌耐藥性的發(fā)展趨勢,探索潛在的用藥風(fēng)險;通過利益集團分析方法,分析我國控制細菌耐藥性策略的可行性,最終提出優(yōu)先控制策略,以達到提高我國控制細菌耐藥性、提高抗菌藥的效果、節(jié)約有限衛(wèi)生資源的目的。 方法: 本研究綜合采用文獻法、訪談法、非接觸性研究方法、統(tǒng)計學(xué)方法、聚類分析方法和利益集團分析方法等多種方法進行研究,搜集的資料包括:(1)國內(nèi)外細菌耐藥研究的文獻資料;(2)國家細菌耐藥監(jiān)測網(wǎng)2001~2005年三級甲等醫(yī)院的耐藥監(jiān)測資料;(3)國家細菌耐藥監(jiān)測網(wǎng)北京、天津、廣東、廣西、遼寧、四川、湖北、浙江8省(市)2001~2005年大腸埃希菌對常見抗菌藥的耐藥數(shù)據(jù)。 結(jié)果與結(jié)論: 1、通過對細菌耐藥性的理論研究,發(fā)現(xiàn)細菌耐藥性的產(chǎn)生和蔓延除了受細菌和藥物自身的特點影響外,人類的活動也能改變細菌耐藥性發(fā)展的速度;有關(guān)細菌耐藥控制的政策包括推行國家基本藥物政策、合理用藥政策、藥品分類管理等;我國細菌耐藥監(jiān)測工作存在覆蓋面不廣、監(jiān)測力度不夠、缺乏交流與協(xié)作、監(jiān)測結(jié)果對臨床反饋不夠、耐藥監(jiān)測與臨床用藥存在脫節(jié)等問題。 2、通過比較國家細菌耐藥性監(jiān)測網(wǎng)2001~2005年三級醫(yī)院的監(jiān)測數(shù)據(jù),發(fā)現(xiàn)G-桿菌占主要地位,尤以大腸埃希菌、銅綠假單胞菌、肺炎克雷伯菌等條件致病菌最為常見。橫向來看,各年臨床分離菌種的排序位置變動不大。 3、以大腸埃希菌作為研究對象,進行細菌耐藥性的“三間”分布研究:(1)時間分布:2001～2005年大腸埃希菌對臨床常用抗菌藥的耐藥率不同,耐藥率整體上呈上升趨勢,尤其是頭孢噻肟、頭孢他啶、頭孢呋辛鈉等,平均每年增加20個百分點;對細菌耐藥率發(fā)展速度大于1的抗菌藥進行預(yù)測,發(fā)現(xiàn)2010年時,頭孢噻肟、頭孢唑林、氨芐西林、頭孢呋辛鈉、萘啶酸、左氧氟沙星等的耐藥率將達到100%。(2)空間分布:細菌耐藥性呈現(xiàn)一定的地區(qū)差異,北京、廣西與四川較為接近,耐藥情況較好,廣東、遼寧與天津較為接近,浙江情況最為嚴重;沿海城市耐藥率與內(nèi)陸城市耐藥情況不同,大腸埃希菌對亞胺培南、頭孢他啶、環(huán)丙沙星、氨曲南的耐藥率都是沿海地區(qū)高于內(nèi)陸地區(qū)且差異有統(tǒng)計學(xué)意義,哌拉西林是內(nèi)陸地區(qū)高于沿海地區(qū)且差異有統(tǒng)計學(xué)意義,頭孢噻肟差異無統(tǒng)計學(xué)意義。(3)抗菌藥間分布:細菌在抗菌藥間的分布不同,青霉素類、磺胺類、四環(huán)素類和喹諾酮類耐藥情況最為嚴重,單環(huán)β-內(nèi)酰胺類、碳青霉烯類等耐藥率比較低。 4、對細菌耐藥控制策略進行相對穩(wěn)定利益集團分析,發(fā)現(xiàn)應(yīng)加強開發(fā)、協(xié)調(diào)政府、衛(wèi)生行政部門和藥品監(jiān)管部門等利益集團,加強對醫(yī)療機構(gòu)位的規(guī)范和管理,加強農(nóng)業(yè)部門、醫(yī)務(wù)人員和有關(guān)企業(yè)的監(jiān)管,加強對耐藥監(jiān)測機構(gòu)和患者的宣傳、教育。對該策略進行相對變動利益集團分析,對于政府應(yīng)加強維持、提高其作用,農(nóng)業(yè)部門、醫(yī)療機構(gòu)、醫(yī)務(wù)人員、有關(guān)企業(yè)應(yīng)加強管理和管制,衛(wèi)生行政部門、藥監(jiān)部門、耐藥監(jiān)測機構(gòu)和患者應(yīng)加強協(xié)作和教育。策略的16條措施中,優(yōu)先措施包括:以微生物學(xué)檢驗結(jié)果為依據(jù)選用抗菌藥、組建或確定國家級細菌耐藥性監(jiān)測中心、建立和開展快速的病原學(xué)診斷方法、為鼓勵開發(fā)新的藥物與疫苗等。 5、指出研究者在考察細菌對抗菌素的耐藥性或敏感性時,發(fā)現(xiàn)應(yīng)該注意研究的年代、國家或地區(qū)、抗菌藥的種類和使用情況,這樣比較的結(jié)果才有實際意義。 6、有關(guān)細菌耐藥水平與抗菌藥的使用量之間的宏觀量化關(guān)系、細菌耐藥水平與抗菌藥不合理使用之間的因果關(guān)聯(lián),需要進一步研究。 建議: 1、政府應(yīng)對細菌耐藥問題給予足夠的重視,真正承擔(dān)起遏制細菌耐藥的責(zé)任。具體包括:(1)建立健全法律法規(guī),進一步加強藥品合理使用和監(jiān)督管理;(2)繼續(xù)深化醫(yī)療衛(wèi)生體制改革;(3)盡快建立一個由國家行政管理機構(gòu)領(lǐng)導(dǎo)的、統(tǒng)一的、權(quán)威的、信息資源共享的細菌耐藥性監(jiān)測系統(tǒng),由國家投入經(jīng)費,對全國監(jiān)測機構(gòu)、醫(yī)院進行組織協(xié)調(diào);(4)加強對有關(guān)行政部門的引導(dǎo)和協(xié)調(diào)作用。(5)采取措施鼓勵疫苗和新抗菌藥的開發(fā)。 2、醫(yī)療機構(gòu)和醫(yī)生切實履行合理使用抗菌藥。具體包括:(1)醫(yī)院制訂臨床抗菌藥物應(yīng)用的指南和處方集;(2)建立藥事管理委員會,加強醫(yī)院內(nèi)的管理措施,建立抗菌藥臨床合理應(yīng)用保障體系;(3)加強細菌耐藥監(jiān)測對臨床抗菌藥使用的反饋,用細菌耐藥監(jiān)測結(jié)果指導(dǎo)抗菌藥的使用;(4)提高病原菌診斷水平,根據(jù)藥敏實驗結(jié)果選擇抗菌藥物;(5)醫(yī)生應(yīng)肩負治療患者的醫(yī)學(xué)責(zé)任和盡可能維持細菌對抗菌藥敏感性的社會責(zé)任。 3、加強教育和宣傳,提高社會各階層對細菌耐藥問題和合理用藥的認知率。 本論文的創(chuàng)新點和下一步需要進行的研究: 創(chuàng)新點:1.本論文首次從宏觀管理的角度,用流行病學(xué)的思路和方法,研究了細菌耐藥性在時間、空間、抗菌藥間的“三間”分布情況。提出研究者在考察細菌耐藥 性時,應(yīng)注意研究的時間、地區(qū)、抗菌藥的種類和使用情況。2.通過利益集團分析方法,分析我國控制細菌耐藥性策略的可行性,提出優(yōu)先控制策略。提出應(yīng)對細菌耐藥這個全球危機不僅要從在微觀上進一步研究細菌耐藥機制和研制新的抗藥藥物,更重要的是,在宏觀上加強對抗菌藥使用的管理和控制,其中政府應(yīng)承擔(dān)主要責(zé)任,具體措施落實在醫(yī)療機構(gòu)和醫(yī)生。 下一步需要進行的研究:有關(guān)細菌耐藥水平與抗菌藥的使用量之間的宏觀量化關(guān)系、細菌耐藥水平與抗菌藥不合理使用之間的因果關(guān)聯(lián)。
[Abstract]:Purpose :


Bacterial resistance has become a global crisis . In order to contain the drug resistance of bacteria , many experts and scholars in our country have carried out the research on the resistance of bacteria . Most of these studies have been carried out from the viewpoint of macro - management . The study aims to study the " three - compartment " distribution of bacterial drug resistance in our country from the perspective of macro - management .


Method :


This paper studied the methods of literature , interview , non - contact , statistics , cluster analysis and interest group analysis . The data collected include : ( 1 ) the literature data of the research on the drug resistance at home and abroad ; ( 2 ) the data of resistance monitoring of the third class A - class hospital in 2001 - 2005 ; ( 3 ) the resistance data of the large intestine Escherichia coli to the common antibiotics in Beijing , Tianjin , Guangdong , Guangxi , Liaoning , Sichuan , Hubei and Zhejiang provinces ( cities ) from 2001 to 2005 .


Results and Conclusions :


1 . Through the theoretical research on the drug resistance of bacteria , it is found that the generation and spread of drug resistance of bacteria can change the speed of drug resistance development in addition to the characteristics of bacteria and drugs . The policies related to drug resistance control include the introduction of national basic drug policy , rational drug administration policy , drug classification management , etc .


2 . By comparing the monitoring data of the national bacterial drug resistance monitoring network from 2001 to 2005 , it was found that the dominant status of G - bacilli , especially in Escherichia coli , Pseudomonas aeruginosa and Klebsiella pneumoniae , was the most common .


3 . The drug resistance rate of E . coli was 100 % . The drug resistance rate of E . coli was 100 % . The drug resistance rate of E . coli was higher than that of inland cities .


4 . To analyze the drug resistance control strategy with a relatively stable interest group . It is found that the development and coordination of interest groups such as the government , the health administration department and the drug regulatory authorities should be strengthened to strengthen the regulation and management of the medical institutions , strengthen the supervision and education of the drug - resistant monitoring institutions and patients , strengthen the management and control of the drug - resistant monitoring bodies and patients , strengthen the management and control of the drug - resistant monitoring bodies and patients , and strengthen cooperation and education . Among the 16 measures of the strategy , the priority measures include the selection of anti - bacterial drugs according to the results of microbiological testing , the establishment or determination of the national - level bacterial drug resistance monitoring centers , the establishment and implementation of rapid pathogenic diagnostic methods , and the development of new drugs and vaccines .


5 . It is pointed out that when investigating the drug resistance or sensitivity of the bacteria to antibiotics , it is found that the study ' s age , country or region , the type and use of the antibacterial drugs should be paid attention to , so that the results of the comparison are practical .


6 . The macro - quantitative relationship between the drug resistance level and the usage amount of the antimicrobial agent , the causal association between the bacterial resistance level and the unreasonable use of the antimicrobial agent , need further study .


Recommendation :


1 . The government should pay enough attention to the problem of bacterial resistance , and truly bear the responsibility to contain the drug resistance of bacteria .


( 3 ) To strengthen the management measures in hospitals , strengthen the management measures in the hospital , establish the clinical rational application guarantee system of the antibacterial drugs , ( 3 ) strengthen the use of the antibiotics to monitor the use of the antibacterial drugs , ( 4 ) improve the diagnostic level of the pathogens , and ( 5 ) the doctor should shoulder the medical responsibility for the treatment of the patient and maintain the social responsibility of the bacteria to the sensitivity of the antibacterial drugs as much as possible .


3 . Strengthen education and publicity , and raise awareness of the drug resistance and rational drug use at all levels of society .


The innovation points and the next step of this thesis need to be studied :


Innovation point : 1 . The paper first studied the distribution of bacteria drug resistance in time , space and anti - bacterial medicine from the perspective of macro - management .


In this paper , we should pay attention to the research time , region , and the types and use of the antimicrobial drugs .


The next step is to investigate the macroscopic quantitative relationship between the level of bacterial resistance and the usage of the antimicrobial agent , the causal association between the level of bacterial resistance and the irrational use of the antimicrobial agent .

【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2007
【分類號】：R378

【引證文獻】

相關(guān)期刊論文 前3條

1 韓晶;;細菌耐藥檢測及抗菌藥物合理應(yīng)用分析[J];臨床合理用藥雜志;2012年22期

2 孫霆芳;曹桂霞;張巧月;;小兒呼吸道感染常見病原菌及藥敏結(jié)果分析[J];現(xiàn)代生物醫(yī)學(xué)進展;2012年20期

3 賀晴;胡國英;樊迪;楊海濱;牟杰;;某院2005-2009年常見抗菌藥物耐藥性分析及用藥選擇[J];中國醫(yī)院藥學(xué)雜志;2011年10期

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本文編號：1695758