骨科患者医院感染病原学分析及抗菌药物合理应用情况调查

摘要

目的 探讨医院骨科住院患者抗菌药物的使用情况,预防医院感染的发生.方法 回顾性分析4 508例住院患者临床资料,根据是否发生医院感染分为感染组(n=104)与非感染组(n= 4 404),分析两组患者抗菌药物使用情况,统计医院感染患者的病原菌分布及药敏实验结果.结果 两组患者不合理应用抗菌药物情况比较差异有统计学意义(P＜0.01),感染组抗菌药物应用不合理率显著高于非感染组(P＜0.01).组感染患者共分离病原菌124株,以革兰氏阳性菌为主,共59株(47.6％),其次为革兰氏阴性菌,共43株(34.7％).真菌22株(17.7％).主要革兰氏阳性菌对氨苄西林、苯唑西林、红霉素、头孢他啶、四环素、替考拉宁耐药率较高,对阿奇霉素、克林霉素、多西环素、米诺环素、万古霉素、亚胺培南药敏率较高.主要革兰氏阴性菌对头孢噻吩、头孢曲松、阿莫西林、氨苄西林、替考拉宁耐药率较高,对亚胺培南、美罗培南、左氧氟沙星、利奈唑胺药敏率较高.结论 抗菌药物的不合理应用增加了骨科患者发生医院感染的几率,临床应以合理应用抗菌药物为基础,做好综合预防措施,降低骨科患者医院感染率,提高治疗水平.%Objective To investigate the use of antibiotics in Department of orthopedics and prevent the occurrence of nosocomial infection. Methods Clinical data of 4508 cases of hospitalized patients were retrospective analyzed, they were divided into the infection group (n = 104) and non infection group (n= 4404) according to whether the occurrence of nosocomial infection, analyze the use of antibiotics, pathogen distribution, drug sensitivity test results of the two groups. Results There was statistic significance in the irrational use of antibiotics between the two groups (P＜0.01),the irrational use of antibiotics rate in the infection group was significantly higher than that in the control group (P＜0.01). There were 124 strains of pathogenic bacteria in the infection group, mainly gram positive bacteria (59 cases,47.6％), followed by gram-negative bacteria (43 cases, 34.7％), fungi (22 cases, 17.7％). The main gram positive bacteria had higher drug resistance rate to ampicillin, oxacillin, erythromycin, tetracycline, teicoplanin,and had higher susceptibility rate to azithromycin, clindamycin, doxycycline, minocycline, vancomycin, imipenem. The main gram negative bacteria had higher drug resistance rate to cefalotin, ceftriaxone, amoxicillin, ampicillin, teicoplanin, and had higher susceptibility rate to imipenem, meropenem, levofloxacin and linezolid. Conclusion The unreasonable application of antibacterial drugs can increase the incidence of hospital infection in Department of orthopedics patients, clinic should be based on rational use of antibiotics, comprehensive preventive measures should be taken to reduce the nosocomial infection rate and improve the level of treatment.