2007—2008年某院抗菌药物的使用情况及鲍曼不动杆菌的耐药性分析

目的对山西医科大学第二医院2007、2008年抗菌药物使用情况和鲍曼不动杆菌耐药性进行分析,为临床用药提供依据。方法采用世界卫生组织(WHO)推荐的限定日剂量(DDD)法分析各种抗菌药的用药频度(DDDs)。采用K-B纸片扩散法对所分离的鲍曼不动杆菌属细菌进行药敏试验,用HONET5.3软件对数据进行统计学分析。结果2007、2008年全年药物销售总金额(不含中药部分)及抗菌药物每年的销售总金额呈上升趋势,但抗菌药物比全年药物销售总金额上升的趋势明显。鲍曼不动杆菌2008年的总菌株比2007年增长了10%,亚胺培南2008年比2007年的耐药率上升幅度大,但仍对亚胺培南保持了比较高的敏感性,对其他11种常用抗菌药物敏感率均>50%,大部分抗菌药物耐药率比2007年有不同程度的增高。结论抗菌药物销售金额和用药频度总体呈上升趋势。鲍曼不动杆菌对亚胺培南仍保持了比较好的敏感性。加酶抑制剂类的药物头孢哌酮+舒巴坦的耐药率相对较低。鲍曼不动杆菌的检出集中在重症监护病房、神经外科、骨科、血液科、呼吸科。

Use of antimicrobial agents and drug resistance of Acinetobacter baumannii in a hospital between 2007 and 2008

Objective To investigate the use of antimicrobial agents and drug resistance in Acinetobacter baumannii from 2007 to 2008 in the Second Hospital of Shanxi Medical University, and to provide evidence for rational use of drugs. Methods Defined daily dosages （DDD） as recommended by WHO were used to evaluate the frequencies of antimicrobial administration. Antibiotic susceptibility test was done by Kirby-Bauer method. The data were analyzed by WHONET5.3 software. Results There was an increasing trend in the total sales amount for all drugs （Chinese herbal drugs excluded）, and more evidently, for antimicrobial agents, during 2007 and 2008. Number of isolated Acinetobacter baumannii strains increased by 101% in 2008 compared with the year 2007. In 2008, A.baumannii strains showed higher resistance yet remained fairly susceptible to imipenem, and were also over 50% susceptible to the other 11 common antimicrobial agents. The rate of drug resistance was higher in 2008 for most antimicrobial agents than in 2007. Conclusion There was an overall rise in use of antimicrobial agents and DDDs. A.baumannii remained fairly susceptible to imipenem as contrasted with other domestic reports. Resistance rates to cefoperazone/sulbactam were relatively low. Origins of Acinetobacter baumannii isolates mainly included ICU and wards of neuresurgery, orthopedics, hematologists and respiratory diseases.