我院革兰阳性菌耐药情况与万古霉素血药浓度监测结果分析

目的：了解我院感染致病菌的分布、主要阳性球菌耐药及万古霉素浓度监测（TDM）情况，为临床合理使用万古霉素提供依据。方法：回顾性总结2012年我院检出感染致病菌的相关数据，并提取我院2012年1月至2013年6月使用万古霉素并进行 TDM 的住院患者病历162份，对其临床资料进行统计分析。结果：阳性菌在我院前十位细菌中所占比例大于20%，万古霉素在临床主要阳性球菌中耐药率为1.04%。结论：万古霉素仍然是针对革兰阳性（G+）菌感染有效的抗菌药，我院万古霉素 TDM 有些病区监测力度不足，应加大宣传，提高临床医生送检意识，万古霉素应根据 TDM 结果及临床表现，为患者制定个体化给药方案，进一步提高药物治疗效果，减少药品不良反应的发生。

Analysis of Gram-positive Bacteria Resistance and Blood Concentration Monitoring Result of Vancomycin in Our Hospital

Objective: To understand the distribution of infection pathogenic bacteria, the main Gram-positive bacteria resistance and therapeutic drug concentration monitoring (TDM) of vancomycin in our hospital, in order to provide the basis for clinical rational use of vancomycin. Methods: The data of infection pathogenic bacteria detected in 2012 were retrospectively summarized, and 162 medical records of inpatients with TDM of vancomycin between January 2012 and June 2013 were extracted, then the clinical data were statistically analyzed. Results: The rate of the Gram-positive bacteria in the top 10 bacteria was accounted for more than 20%, and the rate of Gram-positive bacteria with vancomycin resistance was 1.04%. Conclusion: Vancomycin is still the effective antibiotic against gram-positive bacteria. The strength of vancomycin TDM is insufficient in some ward of our hospital, therefore, we should step up publicity and raise the clinician awareness of the specimen checking, and then develop clinical individualized dosage regimen of vancomycin with reference to TDM and clinical manifestation, thus further improve the effect of drug treatment and reduce the occurrence of drug adverse reactions.