某医院抗菌药物的使用量与革兰阴性杆菌的耐药状况分析

 目的 分析北京某医院2013-01至2015-12常用抗菌药物消耗量及与常见革兰阴性杆菌的耐药状况,为临床医生合理使用抗菌药物,遏制细菌耐药性的增长提供参考。方法 选择2013-01至2015-12北京某综合性医院住院患者常用抗菌药物,利用医院计算机管理软件检索13种常用抗菌药物的品种、出库量、金额,回顾性分析各类抗菌药物的用药频度与耐药状况。结果 3年来,青霉素类、头孢菌素类、氨基糖苷类,以及喹诺酮类抗生素使用量都呈现不同程度下降,而碳青霉烯类与头孢菌素+酶抑制剂的使用量却在上升;4种常见革兰阴性杆菌对于阿莫西林的耐药率最高,均在90%以上,对头孢呋辛的耐药率也在60%以上。对于头孢哌酮舒巴坦的耐药率最低,其对4种常见革兰阴性杆菌均敏感。对于碳青霉烯类、阿米卡星、头孢西丁、头孢他啶及头孢吡肟也有较高的敏感性,除鲍曼不动杆菌外,对其他三种耐药菌均有一定的敏感性。结论 抗菌药物的广泛使用或不合理应用可加速细菌耐药的产生速度;而合理规范使用抗菌药物则有助于延缓细菌耐药性的发展。我院临床分离细菌对常用抗菌药物的耐药性仍不容乐观,为了减少医院感染的发生,我们应当加强抗菌药物的使用管理。

The consumption of antibiotics and the resistant situation of Gram negative bacteria in a Beijing Tertiary Hospital

Objective To analyze the consumption of antibiotics and resistant situation of antimicrobics isolated during January 2013-December 2015 from a Beijing Tertiary Hospital,which could be helpful for the clinical doctors to use antibacterial agents rationally and control the growth of bacterial resistance.Methods The defined daily dose (DDD) method were used to survey the hospital bacteria resistant situation and the antibacterial consumption for inpatients from January 2013 to December 2015.The type of antibacterial agents,the stock-out amount and the amount of money were collected and analyzed retrospectively by the hospital computer management software.Results In the past three years,the consumption of penicillin,cephalosporins,aminoglycoside,and fluoroquinolones showed varying degrees of decline,but,the usage of carbapenems antibiotics and cephalosporin + enzyme inhibitor has been increased;The drug resistance rate of four common gram-negative bacteria for amoxicillin was the highest with more than 90％ and for cefuroxime above 60％ and for cefoperazonesulbactam with the lowest resistant rate,which was sensitive to four common gram negative bacilli.In addition to Bauman Acinetobacter,other three kinds of bacteria,has high sensitivity to carbapenems,Amikacin,cefoxitin,ceftazidime and cefepime.Conclusions The widespread use or irrational use of antibacterial drugs can accelerate the rate of bacterial resistance,while the rational and standardized use of antimicrobial agents can help delay the development of bacterial resistance.Drug resistance of clinical isolated bacteria to antibiotics in our hospital is still not optimistic,in order to reduce hospital infection,we should strengthen the management of antimicrobial drug use.