抗菌药物消耗量与常见革兰阴性细菌耐药性分析

摘要

Objective:To statistic and analyze utilization of antibiotic drugs and resistance rate of gram negative bacteria in a hospital during 2011~2013 , to reduce bacterial resistance and to provide references for clinical rational use of antimicrobial drugs .Methods:Retrospective investigation method was used to statistically analyze the pathogenic bacteria culture results , antimicrobial cumulative fre-quency of each categories and results of drug resistance test.Results:Ranked the top five gram negative pathogens in 2011~2013 year were Escherichia coli,Bauman Acinetobacter,Pseudomonas aeruginosa,Klebsiella pneumoniae and Enterobacter cloacae , the proportion has no obvious changed in each year.The total DDDs of antibacterial drugs reduced year by year , down from 255456.37 DDDs in 2011 to 155024.25 DDDs in 2013 , cephalosporin and enzyme inhibitors and macrolide consumption ranked increased year by year , the three or four generation cephalosporins and quinolones such amount was reduced year by year , antifungal fungi and carbapenem ranking had no obvious changed.All kinds of bacteria were high resistant to amoxicillin , reached 100% in 2013 , Bauman Acinetobacter and Pseudo-monas aeruginosa to piperacillin tazobactam resistant rate increased year by year , Bauman Acinetobacter to beta lactam antibiotics drugs showed a gradual trend of drug resistance.Conclusion:The frequency of antimicrobial drug use showed a declining trend in our hospital , and drug-resistant bacteria rate increased , in order to reduce the resistance present form ,we need to more rational use antimicrobial a-gents.%目的：统计分析我院2011～2013年抗菌药物使用情况及革兰阴性细菌耐药率，为临床降低细菌耐药性和合理使用抗菌药物提供参考依据。方法：采用回顾性调查方法对2011～2013年送检病原菌培养结果、同期各类别抗菌药物累计使用频度和细菌耐药率情况进行统计分析。结果：2011～2013年排名前5位的革兰阴性病原菌均为大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌及阴沟肠杆菌，每年所占比例无明显变化。抗菌药物总用药频度（ DDDs ）逐年减少，从2011年的255456.37 DDDs下降到2013年的155024.25 DDDs，头孢菌素＋酶抑制剂类及大环内酯类用量排名逐年升高，三四代头孢菌素及喹诺酮类用量排名则逐年减少，抗真菌类及碳青霉烯类排名无明显变化。各类细菌对阿莫西林耐药率均较高，2013年基本达到100％，鲍曼不动杆菌及铜绿假单胞菌对哌拉西林他唑巴坦耐药率逐年上升，鲍曼不动杆菌对β-内酰胺类抗菌药物呈逐渐耐药趋势。结论：我院的抗菌药物使用频度呈逐年下降的趋势，而部分细菌的耐药率有增加的趋势，需要更加合理使用抗菌药物，以减缓目前的耐药形势。