细菌耐药--挑战与对策

摘要

当前细菌耐药形势严峻。中国细菌耐药性监测网( CHINET)数据显示，革兰阴性菌分离率逐年上升，其中耐碳青霉烯类肠杆菌科细菌不仅检出率迅速上升，且多为广泛耐药菌株；广泛耐药甚至泛耐药非发酵菌，尤其是鲍曼不动杆菌的分离率仍较高，这些高度耐药的革兰阴性菌所致感染病死率高，已引起临床广泛关注。多重耐药革兰阳性菌方面，耐甲氧西林金黄色葡萄球菌和凝固酶阴性葡萄球菌平均检出率仍较高，耐万古霉素肠球菌分离率稳定，我国尚未分离出耐万古霉素金黄色葡萄球菌。了解本地细菌耐药的流行病学变化，才能根据患者病情制定恰当的用药策略。对于重症感染患者，及早使用抗菌药物、恰当降阶梯治疗可以降低病死率。合理的给药方式可使抗菌药物发挥最大作用，同时注意抗菌药物诱导内毒素释放等影响因素才能提高细菌感染性疾病治疗效果，降低不良反应。%Bacterial resistance to antibiotics is currently a serious health concern.According to the data from the surveil-lance of bacterial resistance in China ( CHINET) ,the isolation rates of gram-negative bacteria have been rising annually. Among the gram-negative organisms, the isolation rate of Carbapenem-resistant enterobacteriaceae, especially extensive drug-resistant strains,has been increasing rapidly.The isolation rate of extensive drug-resistant or pandrug-resistant non-fermenting bacteria,es-pecially Acinetobacter baumanii,is still relatively high.These extensive drug-resistant gram-negative bacteria cause high mortality, which has drawn great attention in clinical settings.On the part of multidrug-assistant gram-positive bacteria,the isolation rate of vancomycin-resistant enterococci remains stable but rates of methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci are still high.Staphylococcal strains have not yet been found resistant to vancomycin in China.Understanding the epi-demiology of local drug-resistant bacteria facilitates the development of appropriate antibiotic strategies. The mortality of patients with severe infection may be improved by early use of antibiotics and appropriate de-escalation therapy.Rational use of antibiotics and recognition of the influence factors,such as antibiotic-induced endotoxin release,may maximize the efficacy of antibiotics and minimize the adverse reactions.