某院595例多重耐药菌检出患者情况调查分析

摘要/Abstract

摘要： 目的：分析多重耐药菌检出患者的情况，进一步探索临床药师促进临床合理用药的方法。方法：回顾性分析2018年1月至2019年12月我院595例多重耐药菌检出患者的基本情况、菌种分布、科室分布、标本来源、合理用药情况。结果：多重耐药菌检出患者年龄≥60岁占比54.96%，检出菌株革兰氏阴性杆菌占比79.83%，革兰氏阳性球菌占比20.17%。全院共21个病区，均检出多重耐药菌。送检标本中，呼吸道标本占比36.97%，尿液标本占比26.55%，伤口脓液标本占比18.49%。抗菌药物应用合理率为67.40%，不合理用药情况占比较多的为：未区分污染菌、定植菌、感染菌占比31.96%；用法用量不适宜占比31.44%；遴选药物不适宜占比20.10%。结论：检出多重耐药菌的患者抗菌药物应用合理率较低。临床药学室需要联合微生物室、感控科优化多重耐药菌处置流程，加强培训，临床药师应及时指导临床合理应用抗菌药物，提高抗菌药物合理应用水平。

关键词: font-size:medium, ">临床药师；多重耐药菌；抗菌药物合理应用；药学服务

Abstract: Objective： To analyze the situation of patients with multi-drug resistant bacteria detected and to further explore how the clinical pharmacists to guide the rational use of drugs. Methods: The basic information, bacterial species distribution, department distribution, specimen source and rational drug use of 595 patients with multi-drug resistant bacteria detected in our hospital from January 2018 to December 2019 were retrospectively analyzed. Results: 54.96% of the patients with multi-drug resistant bacteria detected were ≥60 years old. The gram-negative bacilli accounted for 79.83%, and the gram-positive cocci accounted for 20.17%. There are 21 wards in the whole hospital, and the multi-drug resistant bacteria were detected in every ward. Among the specimens, respiratory specimens accounted for 36.97%, urine samples accounted for 26.55%, and wound pus samples accounted for 18.49%. The rational rate of antibacterial drug application was 67.40%. The irrational drug use mainly were: confusion of pathogenic bacteria, colonized bacteria and contaminated bacteria accounted for 31.96%, inappropriate usage and dosage accounted for 31.44%, inappropriate selection of drugs accounted for 20.10%. Conclusion: The rational rate of antibacterial drug application in patients with multi-drug resistant bacteria detected is low. The clinical pharmacy department needs to cooperate with the microbiology department and infection control department to optimize the treatment process of multi-drug resistant bacteria, strengthen training, and clinical pharmacists should timely guide the rational use of antibacterial drugs to improve the level of rational use of antibacterial drugs.

Key words: font-size:medium, ">Clinical pharmacist； Multi-drug resistant bacteria；Rational use of antibacterial drugs； Pharmaceutical service

中图分类号:

田娜妮, 何青青, 朱琳, 刘春莹, 梁乐. 某院595例多重耐药菌检出患者情况调查分析[J]. 中国医药导刊, 2021, 23(6): 468-472.

TIAN Nani, HE Qingqing, ZHU Lin, LIU Chunying, LIANG Le. Investigation and Analysis of 595 Patients with Multi-Drug Resistant Bacteria Detected in a Hospital[J]. CHINESE JOURNAL OF MEDICINAL GUIDE, 2021, 23(6): 468-472.

参考文献

[1]国家卫生计生委，国家发展改革委，教育部，等.关于印发遏制细菌耐药国家行动计划（2016-2020年）的通知[EB/OL]. (2016-08-25) [2021-02-02]. http：//www. nhc. gov. cn/yzygj/s3593/201608/f1ed26a0c8774e1c8fc89dd481ec 84d7. shtml
     [2]戴维.吉尔伯特等著.范洪伟，等译.热病-桑福德抗微生物治疗指南（第48版）[M]. 中国协和医科大学出版社，2019.
     [3]CLSl. Performance Standards for Antimicrobial Susceptibility Testing[S]. 30th ed. CLSI supplement M100. Wayne， PA： Clinical and Laboratory Standards Institute， 2020.
     [4]原国家卫生与计划生育委员会.抗菌药物临床应用指导原则(2015年版).[EB/OL]. (2015-08-27) [2021-02-02]. http：//www.nhc.gov.cn/ewebeditor/uploadfile/2015/09/20150928170007470.pdf
     [5]中华预防医学会医院感染控制分会，中华医学会感染病学分会，中国医院协会医院感染管理专业委员会，等. 中国碳青霉烯耐药革兰阴性杆菌(CRO)感染预防与控制技术指引[J]. 中华医院感染学杂志，2019，29(13)：2075-2080.
     [6]Liu C， Bayer A， Cosgrove SE， et al. Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and Children[J]. Clin Infect Dis， 2011，52(3)：e18-55.
     [7]黄勋，邓子德，倪语星，等.多重耐药菌医院感染预防与控制中国专家共识[J]. 中国感染控制杂志，2015，14(1)：1-9.
     [8]葛芳，黄丽晴，毛美琴.多重耐药菌感染的危险因素与防控措施[J]. 中国消毒学杂志，2017，34(3)：292-294.
     [9]周芳，董亚琳.ICU多重耐药菌医院感染的危险因素分析[J]. 中国药房，2017，28(14)：1916-1920.
     [10]Skjot-Arkil H， Mogensen CB， Lassen AT， et al. Carrier prevalence and risk factors for colonisation of multiresistant bacteria in Danish emergency departments： a cross-sectional survey[J]. BMJ Open， 2019， 9(6)：e029000.
     [11]Latour K， Huang TD， Jans B， et al. Prevalence of multidrug-resistant organisms in nursing homes in Belgium in 2015[J]. PLoS ONE， 2019，14(3)：e0214327.
     [12]Kateete DP， Asiimwe BB， Mayanja R， et al. Species and drug susceptibility profiles of staphylococci isolated from healthy children in Eastern Uganda[J]. PLoS ONE， 2020，15(2)：e0229026.
     [13]Tacconelli E， Carrara E， Savoldi A， et al. Discovery， research， and development of new antibiotics： the WHO priority list of antibiotic-resistant bacteria and tuberculosis[J]. Lancet Infect Dis， 2018，18(3)：318-327.
     [14]周华，周建英，俞云松.多重耐药革兰阴性杆菌感染诊治专家共识解读[J]. 中华内科杂志.2014，53(12)：984-987.
     [15]《β-内酰胺类抗生素/β-内酰胺酶抑制剂复方制剂临床应用专家共识》编写专家组，俞云松.β-内酰胺类抗生素/β-内酰胺酶抑制剂复方制剂临床应用专家共识(2020年版)[J]. 中华医学杂志，2020，100(10)：738-747.
     [16]Brook I. Spectrum and treatment of anaerobic infections[J]. J Infect Chemother， 2016，22(1)：1-13.
     [17]中华医学会临床药学分会《雾化吸入疗法合理用药专家共识》编写组.雾化吸入疗法合理用药专家共识( 2019年版) [J]. 医药导报，2019，38(2) ： 135-146．
     [18]王燕萍，陈娅，武新安，等.慢性骨髓炎的病原学特点及抗菌药物治疗进展[J]. 中国药房，2015，26(20)：2867-2870.

快速检索引用检索图表检索高级检索