第三代头孢菌素的用药频度与耐药现状分析

目的了解某城市对第三代头孢菌素(简称TGC)的使用情况和使用水平以及临床分离的革兰阴性杆菌(G杆菌)对TGC的耐药现状,为科学合理使用该类抗生素提供必要参考依据。方法以5家有代表性的医院-3年间(2000—2002)对TGC的使用消耗情况以及临床药敏试验结果为分析样本,采用世界卫生组织(WHO)推荐的限定日剂量(defineddailydose,DDD)法分析各种抗菌药的用药频度(DDDs),即治疗日数;采用纸片扩散法、Microscan系统的Mic法进行药敏试验并严格按照美国临床实验室标准化委员会(NCCLS)1999年制定的规则进行操作及判读。结果摇3年来TGC总的DDDs为130.64万个治疗日,其中2000、2001、2002年的MF分别为33.35、43.12、54.17万个治疗日;3年来头孢曲松、头孢噻肟、头孢他啶、头孢哌酮的DDDs分别为73.39、25.66、21.65、9.94万个治疗日。3年来G杆菌对TGC的平均耐药率为40郾92%,其中2000、2001、2002年的耐药率分别为30郾04%、41郾05%、-42郾58%。G杆菌对头孢曲松、头孢噻肟、头孢他啶、头孢哌酮的耐药率分别为51郾43%、46郾02%、33郾17%、33郾08%。结-论摇TGC的使用过多过滥,细菌耐药水平高。DDDs增长过高过快,导致G杆菌对TGC的耐药率不断上升,且DDDs-值越大,细菌耐药率越高。提示临床应高度重视DDDs与细菌耐药的关系及其带来

Status quo analysis on medication frequency and drug resistance of the third generation cephalosporins

Objective In a city scope,to investigate the medication condition of the third generation cephalosporins (TGC) and the drug resistance of Gram-negative bacillus isolated from clinics to TGC,so as to provide a necessary reference to scientific and rational use of this kind of antibiotics.Methods Five hospitals with representativeness in our city were chosen as subject,their consumption of TGC and data of clinical sensitivity test during 2000-2002 were used as samples for this study according to the WHO-recommended DDD method (defined daily dose method) to probe into medication frequency (DDDs) and therapeutic time (days);using paper diffusion and Mic method of Microscan system to make drug sensitive test,judging the data obtained according to the National Committee for Clinical Laboratory Standards 1999 (NCCLS 1999). Results The three years of 2000,2001,and 2002 saw the total medication frequency of TGC was 1 306 400 days,ie,333 500 days,431 200 days and 541 700 days respectively;the three years witnessed that ceftriaxone,cefotaxime,ceftazidime,and cefoperazone had got medication frequencies of 733,900 days,256 600 days,216 500 days and 99 400 days respectively.The three years also found that the Gram-negative bacillus got an average drug-resistance of 40.92%,ie,39.04% for 2000,41.05% for 2001 and 42.58% for 2002.Gram-negative bacillus showed resistance to ceftriaxone,cefotaxime,ceftazidime,and cefoperazone in percentages of 51.43%,46.02%,33.17% and 33.08%. Conclusion Abuse or excessive use of TGC makes high the bacillus′ resistance;the more quicklier the medication frequency increases,the more strong the Gram-negative bacillus′ resistance becomes.It is suggested that attention must be paid to the relationship of high medication frequency with bacillus′ resistance and its harmfulness;scientific and rational use of TGC and lowering their medication frequency can postpone or reduce the occurrence of bacillus′ resistance,insuring the safety and effectiveness of the TGC use.