【摘要】 目的了解2011—2015年抗菌药物专项整治前后常见病原菌分布及耐药性变迁,为指导抗菌药物临床应用提供依据。方法收集2011—2015年某院住院患者抗菌药物使用情况及患者分离病原菌,分析主要病原菌对常见抗菌药物的耐药率变化趋势。结果2011—2015年住院患者抗菌药物使用率从75.84%下降至37.35%,抗菌药物使用强度从59.53/(100例患者·d)下降至33.63/(100例患者·d),均呈下降趋势(均P<0.05)。共分离病原菌10 091株,其中革兰阳性菌2 338株,占23.17%;革兰阴性菌7 110株,占70.46%;真菌643株,占6.37%。居前5位的病原菌为大肠埃希菌(20.85%)、肺炎克雷伯菌(15.90%)、铜绿假单胞菌(11.70%)、金黄色葡萄球菌(7.35%)和鲍曼不动杆菌(6.82%)。主要病原菌对常用抗菌药物耐药率呈下降趋势,其中大肠埃希菌和肺炎克雷伯菌对哌拉西林/他唑巴坦、头孢西丁、阿米卡星的耐药率下降最明显(2015年均<4%);铜绿假单胞菌较鲍曼不动杆菌对常用抗菌药物的敏感性整体较高,对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢他啶、头孢吡肟、阿米卡星、环丙沙星耐药率下降明显,对上述药物的耐药率<20%,对碳青霉烯类抗生素的耐药率高于其他常用药物;鲍曼不动杆菌对阿米卡星、左氧氟沙星耐药率下降最明显,但对美罗培南、亚胺培南耐药率明显上升,至2015年,耐药率均>50%。金黄色葡萄球菌对氟喹诺酮类药物耐药率下降最明显(<2%),未见耐万古霉素菌株。结论常见病原菌的耐药率随着抗菌药物专项整治后抗菌药物使用量的下降均有不同程度的下降,抗菌药物合理使用与延缓细菌耐药可能有关。更多还原

【Abstract】 Objective To understand the distribution and change in drug resistance of common pathogens before and after the implementation of special rectification activity on antimicrobial use in 2011-2015,and provide guidance for clinical application of antimicrobial agents.Methods Antimicrobial use in hospitalized patients and pathogens isolated from patients in a hospital from 2011 to 2015 were collected,changing trend of resistance rates of major pathogens to commonly used antimicrobial agents was analyzed.Results From 2011 to 2015,antimicrobial utilization rate in hospitalized patients dropped from 75.84% to 37.35%,antimicrobial use density decreased from 59.53 per 100 patient days to 33.63 per 100 patient days,both showed a downward trend(both P<0.05).A total of 10 091 strains of pathogens were isolated,2 338(23.17%)of which were gram-positive bacteria,7 110(70.46%)were gram-negative bacteria,and 643(6.37%)were fungi.The top five pathogens were Escherichia coli(20.85%),Klebsiella pneumoniae(15.90%),Pseudomonas aeruginosa(11.70%),Staphylococcus aureus(7.35%),and Acinetobacter baumannii(6.82%).Resistance rates of major pathogens to commonly used antimicrobial agents decreased year by year(P<0.05),resistance rates of Escherichia coli and Klebsiella pneumoniae to piperacillin/tazobactam,cefoxitin,and amikacin declined most obviously(all<4%in 2015);compared with Acinetobacter baumannii,Pseudomonas aeruginosa had higher sensitivity to commonly used antimicrobial agents,resistance rates to piperacillin/tazobactam,cefoperazone/sulbactam,ceftazidime,cefepime,amikacin,and ciprofloxacin decreased obviously,resistance rate to above antimicrobial agents was<20%,to carbapenems was higher than other commonly used antimicrobial agents.Resistance rates of Acinetobacter baumannii to amikacin,levofloxacin decreased most obviously,to meropenem and imipenem increased obviously,in 2015 were both above 50%.Resistance rate of Staphylococcus aureus to fluoroquinolones declined most obviously(<2%),vancomycin-resistant strains were not found.Conclusion After the implementation of special rectification activity,resistance rates of common pathogens decreased with the decline of antimicrobial use,rational use of antimicrobial agents may be related to delaying bacterial resistance.更多还原