临床感染病原菌的变迁及其与抗菌药物应用的关系

目的:分析医院病原菌的结构和耐药的变迁趋势,探讨病原菌的变迁与临床抗菌药物使用的关系。方法:对解放军总医院第一附属医院1995年以来11年临床标本病原菌的分离鉴定结果进行统计分析,结合同期临床抗菌药物的使用强度,分析病原菌变迁与抗菌药物使用的相关性。结果:11年间从临床标本中共分离出病原菌15914株。①G 菌中金黄色葡萄球菌(金葡菌)和耐甲氧西林金葡菌(MRSA)的构成比上升趋势明显,凝固酶阴性葡萄球菌(CNS)和肠球菌属的构成比波动幅度较大,但变化趋势不明显。G-菌中,铜绿假单胞菌的构成比虽有波动,但始终维持在高水平;大肠杆菌和变形杆菌的构成比明显下降,不动杆菌的构成比明显上升。②1995年构成比最高的3种病原菌依次为大肠杆菌、铜绿假单胞菌和金葡菌,2005年变为铜绿假单胞菌、金葡菌和不动杆菌。③我院抗菌药物的使用强度在2005年达70DDD/100人天,使用最多的药物种类为喹诺酮类、二代头孢菌素和含酶抑制剂的三代头孢菌素;单一品种药物为左氧氟沙星、头孢呋辛和阿奇霉素。④大环内酯类、糖肽类、碳青霉烯类和3代头孢/抑制剂等药物的使用强度变化与多种病原菌构成比的变化呈显著正相关,MR-SA构成比的变化与多种药物使用强度变化呈显著正相关。结论:常见病原菌的耐药水平逐渐升高,将会增大抗感染治疗的难度;抗菌药物使用强度的变化有可能导致病原菌结构和耐药水平的变化。

The vicissitude of pathogens of infection and its relation with the use of antibiotics

Objective: To investigate the vicissitude of pathogens of infection and its relation with the use of antibiotics in our hospital. Methods:The constituent ratio of different bacteria in all infectious pathogens and the data of antibiotics consumption in our hospital were analyzed. Results:More than ten thousand of bacteria were isolated from clinical specimens in an 11-year period. The constituent ratio of S. aureus and MRSA were gradually increased, and the constituent ratio of P. aeruginosa was fluctuating at a high level. A trend of increase was found in constituent ratio of Acinetobacter. The consumption of antibiotic in our hospital was 70 DDD/100 bed day at 2005, and the most frequently used antibiotics were levofloxacin, cefuroxime and azithromycin.Significant correlation coefficients were found in macrolides, glycopeptides and carbopenem to common pathogens. Conclusion:The results suggest that more difficulty might be encountered in infection treatment with the increase of antibiotic resistance level of bacteria. On the other hand, the changes in antibiotic administration might lead to changes in pathogens of infections. Therefore, it is important to adjust the strategy of infection control and treatment based on the vicissitude of pathogens.