某医院心内科住院病人抗菌药物应用与耐药性分析
|
摘要
目的分析心内科住院病人抗菌药物使用情况和细菌对药物的耐药性,为临床合理使用抗菌药物提供参考。方法回顾性分析2017年1—6月广西壮族自治区民族医院2 685例住院病人的临床资料,其中使用抗菌药物463例,对抗菌药物应用、标本送检情况及病原菌的耐药性进行统计分析。结果心内科抗菌药物使用率为17.2%;使用频度以头孢哌酮舒巴坦最高,为2 090.78;限制级与特殊级抗菌药物使用率分别为93.5%和6.9%;微生物送检率为68.4%,阳性检出率为14.8%;共分离出病原菌47株,其中革兰阴性菌39株,革兰阳性菌和真菌均为4株,占比分别为83.0%、8.5%和8.5%,革兰阴性菌以大肠埃希菌为主;大肠埃希菌对碳青霉烯类、阿米卡星、哌拉西林他唑巴坦、头孢哌酮舒巴坦及头孢他啶100.0%的敏感,对氨苄西林舒巴坦、头孢曲松、环丙沙星和左氧氟沙星有较高的耐药率,分别为28.6%、23.8%、23.8%及23.8%。结论心内科抗菌药物使用情况总体合理,但仍存在一些问题;需加强管理抗菌药物的应用及细菌耐药监测,促进抗菌药物合理使用。
Objective To investigate the utilization and drug resistance of antibacterial drugs in inpatients of cardiology department,so as to provide references for the clinical rational use of antibacterial drugs.Methods The clinical data of antibacterial drugs usage in 463 of 2 685 inpatients in cardiology department in Minzu Hospital of Guangxi Zhuang Autonomous Region from January 2017 to June 2017 were retrospectively analyzed.Then the utilization,specimen submission and drug resistence of antibacterials were statistically analyzed.Results The usage rate of antibacterial drugs in cardiology department was 17.2%.The using frequency at the highest was Cefoperazone Sulbactam(2090.78).The usage rates of restricted and special class of antibacterials were 93.5% and 6.9% respectively.The rate of microscopic examination was 68.4%,and the positive detection rate was 14.8%.Totally 47 strains of pathogens were isolated,including 39(83.0%) strains of gram-negative bacteria,4(8.5%) strains of gram-positive bacteria and 4(8.5%) strains of fungi.Escherichia coli were the predominant gram-negative bacteria.The drug resistance rate of Escherichia coli to Carbapenem,Amikacin,Piperacillin tazobactam,Cefoperazone sulbactam and Ceftazidime were 100.0%.The drug resistance rates of Escherichia coli to Ampicillin sulbactam,Ceftriaxone,Ciprofloxacin and Levofloxacin were 28.6%,23.8%,23.8% and 23.8% respectively.Conclusions Usage of antimicrobial drugs in cardiology department was generally reasonable,but some problems still existed.It is necessary to further strengthen the management of the clinical application of antimicrobial drugs and the monitoring of drug resistance,so as to promote the clinical rational use of antimicrobial drugs.
Objective To investigate the utilization and drug resistance of antibacterial drugs in inpatients of cardiology department,so as to provide references for the clinical rational use of antibacterial drugs.Methods The clinical data of antibacterial drugs usage in 463 of 2 685 inpatients in cardiology department in Minzu Hospital of Guangxi Zhuang Autonomous Region from January 2017 to June 2017 were retrospectively analyzed.Then the utilization,specimen submission and drug resistence of antibacterials were statistically analyzed.Results The usage rate of antibacterial drugs in cardiology department was 17.2%.The using frequency at the highest was Cefoperazone Sulbactam(2090.78).The usage rates of restricted and special class of antibacterials were 93.5% and 6.9% respectively.The rate of microscopic examination was 68.4%,and the positive detection rate was 14.8%.Totally 47 strains of pathogens were isolated,including 39(83.0%) strains of gram-negative bacteria,4(8.5%) strains of gram-positive bacteria and 4(8.5%) strains of fungi.Escherichia coli were the predominant gram-negative bacteria.The drug resistance rate of Escherichia coli to Carbapenem,Amikacin,Piperacillin tazobactam,Cefoperazone sulbactam and Ceftazidime were 100.0%.The drug resistance rates of Escherichia coli to Ampicillin sulbactam,Ceftriaxone,Ciprofloxacin and Levofloxacin were 28.6%,23.8%,23.8% and 23.8% respectively.Conclusions Usage of antimicrobial drugs in cardiology department was generally reasonable,but some problems still existed.It is necessary to further strengthen the management of the clinical application of antimicrobial drugs and the monitoring of drug resistance,so as to promote the clinical rational use of antimicrobial drugs.
引文
[1] 国家食品药品监督管理总局.国家药品不良反应监测年度报告(2016 年)[R/OL].(2017-04-28)[2017-11-11].http://samr.cfda.gov.cn/WS01/CL0844/172167.html.
[2] 郑丽娜,李云霞,吴静.抗菌药物不良反应分析[J].中华医院感染学杂志,2016,26(10):2378-2380.
[3] 国家卫生和计划生育委员会.中国抗菌药物管理和细菌耐药现状报告(2017)[M].北京:中国协和医科大学出版社,2017.
[4] 胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[5] HU FP,GUO Y,ZHU DM,et al.Resistance trends among clinical isolates in China reported from CHINET surveillance of bacterial resistance,2005-2014[J].Clin Microbiol Infect,2016,22 (Suppl 1):s9-s14.
[6] 许敬菊,程慎令,丛晓荣.头孢哌酮/舒巴坦治疗下呼吸道感染的疗效及耐药趋势分析[J].中华医院感染学杂志,2015,25(1):91-93.
[7] GHONIM S,DUBREY SW.Overwhelming infection causing takotsubo syndrome[J].Br J Hosp Med (Lond),2014,75(4):234-235.
[8] 张桂芳,刘向欣,孙海艳,等.老年心肌梗死患者留置导尿管与泌尿系统感染的相关性研究[J].中华医院感染学杂志,2015,25(23):5412-5414.
[9] 余晗俏,俞章平,钟忆周.心内科住院患者医院感染病原菌与耐药性分析[J].中华医院感染学杂志,2015,25(9):1962-1964.
[10] 张俏,郭焕菊.心血管内科住院患者医院感染高危因素分析[J].中国感染控制杂志,2015,14(6):409-411.
[11] 蒙光义,潘鹏,王冬晓,等.医院常见革兰阴性菌的临床分布及耐药性分析[J].中国医院药学杂志,2016,36(6):488-491.
[12] 王姣平,周发为.医院产超广谱β-内酰胺酶大肠埃希菌临床分布及其耐药性的分析[J].中国医院药学杂志,2016,36(13):1121-1124.
[13] 史宝玉,谭晓武,姜艳.产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌的耐药性调查分析[J].中国实验诊断学,2015,19(5):765-769.
[14] 张祎博,孙景勇,倪语星,等.2005—2014年CHINET铜绿假单胞菌耐药性监测[J].中国感染与化疗杂志,2016,16(2):141-145.
[15] NIKAIDO H,PAGèS JM.Broad-specificity efflux pumps and their role in multidrug resistance of Gram-negative bacteria[J].FEMS Microbiol Rev,2012,36(2):340-363.
[16] 周莹,陈杏春,梁亮,等.医院获得性铜绿假单胞菌感染的临床分布与耐药性分析[J].中华医院感染学杂志,2015,25(12):2681-2683.
[17] 中华医学会呼吸病学分会感染学组.铜绿假单胞菌下呼吸道感染诊治专家共识[J].中华结核和呼吸杂志,2014,37(1):9-15.
[18] 王明贵.广泛耐药革兰阴性菌感染的实验诊断、抗菌治疗及医院感染控制:中国专家共识[J].中国感染与化疗杂志,2017,17(1):82-93.
[19] 陈代杰,郭蓓宁,杨信怡,等.鲍曼不动杆菌耐药机制[J].中国感染与化疗杂志,2015,15(3):286-288.
[20] 胡伟,张婷,孙成,等.某三甲医院2012-2015年抗菌药物使用强度与鲍曼不动杆菌耐药性的相关性分析[J].安徽医药,2017,21(7):1339-1341.
[2] 郑丽娜,李云霞,吴静.抗菌药物不良反应分析[J].中华医院感染学杂志,2016,26(10):2378-2380.
[3] 国家卫生和计划生育委员会.中国抗菌药物管理和细菌耐药现状报告(2017)[M].北京:中国协和医科大学出版社,2017.
[4] 胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[5] HU FP,GUO Y,ZHU DM,et al.Resistance trends among clinical isolates in China reported from CHINET surveillance of bacterial resistance,2005-2014[J].Clin Microbiol Infect,2016,22 (Suppl 1):s9-s14.
[6] 许敬菊,程慎令,丛晓荣.头孢哌酮/舒巴坦治疗下呼吸道感染的疗效及耐药趋势分析[J].中华医院感染学杂志,2015,25(1):91-93.
[7] GHONIM S,DUBREY SW.Overwhelming infection causing takotsubo syndrome[J].Br J Hosp Med (Lond),2014,75(4):234-235.
[8] 张桂芳,刘向欣,孙海艳,等.老年心肌梗死患者留置导尿管与泌尿系统感染的相关性研究[J].中华医院感染学杂志,2015,25(23):5412-5414.
[9] 余晗俏,俞章平,钟忆周.心内科住院患者医院感染病原菌与耐药性分析[J].中华医院感染学杂志,2015,25(9):1962-1964.
[10] 张俏,郭焕菊.心血管内科住院患者医院感染高危因素分析[J].中国感染控制杂志,2015,14(6):409-411.
[11] 蒙光义,潘鹏,王冬晓,等.医院常见革兰阴性菌的临床分布及耐药性分析[J].中国医院药学杂志,2016,36(6):488-491.
[12] 王姣平,周发为.医院产超广谱β-内酰胺酶大肠埃希菌临床分布及其耐药性的分析[J].中国医院药学杂志,2016,36(13):1121-1124.
[13] 史宝玉,谭晓武,姜艳.产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌的耐药性调查分析[J].中国实验诊断学,2015,19(5):765-769.
[14] 张祎博,孙景勇,倪语星,等.2005—2014年CHINET铜绿假单胞菌耐药性监测[J].中国感染与化疗杂志,2016,16(2):141-145.
[15] NIKAIDO H,PAGèS JM.Broad-specificity efflux pumps and their role in multidrug resistance of Gram-negative bacteria[J].FEMS Microbiol Rev,2012,36(2):340-363.
[16] 周莹,陈杏春,梁亮,等.医院获得性铜绿假单胞菌感染的临床分布与耐药性分析[J].中华医院感染学杂志,2015,25(12):2681-2683.
[17] 中华医学会呼吸病学分会感染学组.铜绿假单胞菌下呼吸道感染诊治专家共识[J].中华结核和呼吸杂志,2014,37(1):9-15.
[18] 王明贵.广泛耐药革兰阴性菌感染的实验诊断、抗菌治疗及医院感染控制:中国专家共识[J].中国感染与化疗杂志,2017,17(1):82-93.
[19] 陈代杰,郭蓓宁,杨信怡,等.鲍曼不动杆菌耐药机制[J].中国感染与化疗杂志,2015,15(3):286-288.
[20] 胡伟,张婷,孙成,等.某三甲医院2012-2015年抗菌药物使用强度与鲍曼不动杆菌耐药性的相关性分析[J].安徽医药,2017,21(7):1339-1341.