重庆地区儿科第三代头孢菌素的使用与革兰阴性杆菌耐药现状分析

目的:了解重庆地区儿科第三代头孢菌素(TGC)的使用与临床分离G-杆菌的耐药情况,为临床合理使用TGC,遏制G-杆菌耐药分离株的增长提供参考.方法:从医院HIS系统中提取2002年1月至2005年12月所有来院就诊病人消耗的TGC药品资料,并统计TGC的用药频度;微生物室的细菌学检查按照卫生部医政司编写的《全国临床检验操作规程》进行培养,分离鉴定细菌,药敏采用Kirby-Bauer纸片扩散法,收集同期全院所有临床科室在细菌室的送检标本和G-杆菌检测结果的详细资料进行统计分析.结果:4年中消耗TGC的DDDs和金额分别占同期抗生素的6.42%和15.23%,单品种主要集中在头孢曲松、头孢噻肟、头孢他啶、头孢哌酮等4个品种上;临床分离菌株以G-杆菌为主,占临床分离菌株的67.96%,其中以大肠埃希氏菌(38.38%)、肺炎克雷伯菌(34.83%)、铜绿假单胞菌(13.36%)和流感嗜血杆菌(9.51%)为主;4年中G-杆菌对4个TGC品种的耐药率分别为45.56%、40.19%、47.75%和48.28%,TGC消耗量(DDDs)与G-杆菌耐药率之间具有相关性(r=0.7751,P=0.039).结论:要遏制G-杆菌耐药性的快速增长,规范和合理使用TGC是关键措施之一.

An analylsis of the application of the third generation cephalosporins and the antibiotic resistance of gram negative bacilli

Objective:To learn the application of the third generation cephalosporins (TGC) and the resistance of gram negative bacilli (GNB). Method: Based on the hospital information system (HIS), numerical data about TGC consumption from 2002.1 to 2005.12 were collected. The utilizing frequency of TGC were calculated. The suceptibility tests were performed on the GNB separated from the clinical samples and the results were analyzed. Results: The percentage of the DDDs and the amount of money of TGC in the 4 years were 6.42% and 15.23% respectively and the major 4 kinds of drugs were ceftriaxone, cefotaxime, ceftazidime and cefoperazone. 67.96% seperated microbes was GNB and Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Hemophilies influenzae occupied the top 4. Drug fast rates of GNB to the 4 TGCs were 45.56%, 40.19%, 47.75% and 48.28% respectively. There is a direct correlation between the DDDs of TGC and the drug fast rates. Conclusions: To regularize the application of TGC is important for inhibiting the fast increasing drug resistance of GNB.