摘要
目的了解长春市儿科抗生素使用现状，检测细菌的耐药性，指导临床合理用药。方法采用回顾性调查方法，对长春市某三甲综合医院2003年1月～2005年11月900例感染性疾病患儿抗生素使用情况进行统计分析。采集2004年12月～2005年11月儿科各种标本，按照《临床医学检验手册》常规方法进行细菌分离及鉴定，采用Kirby-Bauyer琼脂扩散法进行分离菌的药敏试验，结果按照美国国家临床实验室标准委员会（2004）标准判读。结果病例均使用抗生素，包括4类11种抗生素，使用率高的前6种抗生素分别是头孢替唑（22.3％）、头孢哌酮／舒巴坦（21.6％）、阿莫西林／克拉维酸钾（19.6％）、青霉素（17．2％）、阿齐霉素（16.4％）、苯唑西林（10．1％）。单用抗生素占60．6％，两联用药占70．7％；静脉给药占81．7％。口服给药占18.3％。分离出818株细菌，革兰阳性球菌393株，占48.0％；革兰阴性杆菌425株，占52．0％。细菌对青霉素类和头孢菌素类的耐药率均较高，革兰阳性菌对青霉素的耐药率均超过50．0％，金黄色葡萄球菌、凝固酶阴性葡萄球菌、肠球菌、肺炎球菌对红霉素的耐药率均超过71.4％。对头孢类抗生素的耐药率均超过35．7％。革兰阳性菌对万占霉素均敏感，对亚胺培南、环丙沙星的耐药率均低于25．0％。革兰阴性菌对氨苄西林耐药率超过83.0％。对哌拉西林、阿莫西林／克拉维酸钾耐药率，除铜绿假单胞菌（33．3％）外，均超过68.9％，对头孢类抗生素耐药率（除头孢他定外）均超过40.0％，对阿米卡星、环丙沙星的耐药率均低于28.0％；对亚胺培南耐药率最低，除绿脓杆菌外，其他细菌不超过8．4％。结论长春市儿科抗生素使用率高，且存在许多不合理现象。儿科标本分离出的细荫对抗生素耐药率高，且多重耐药现象严重。开展细菌的分离及耐药性检测对指导临床合理使用抗生素具有重要意义。
Objective To investigate the usage of antibiotics in pediatrics patients in Changchun, and detect the bacterial drug resistance of main pathogens for direction of the appropriate clinical choice of drug antibiotics. Methods A total of 900 cases of infectious patients were retrospectively investigated in antibiotic usage in the Ⅲ A hospital in Changchun from January 2003 to November 2005 and the data were statistics analyzed. The bacterium were isolated from all kinds of specimen of children in hospital patients from December 2004 to November 2005, according to the method of ＂Clinical Medicine Test Handbook＂. All bacterial isolated from bacterial susceptibility testing was done with Kirby - Bauer method. Tests were performed according to the guidelines of National Committee for Clinical Laboratory Standards （NCCLS） （2004）. Results Antibiotics were administered in all of the cases. Four categories and 11 kinds of antibiotics were used. Usage of the first six antibiotics were as followed： ceftezole （22.3 %）, cefoperazone - sulbactam （21.6 %）, amoxicillin clavulanic acid （19.6 %）, penicilin （17.2 %）, azithromycin （16.40 %）, oxacillin （10.1%）. The rate of antibiotic use was 60.6 % for solo use, 70.7 % for bigeminy use, 81.7% for intravenously guttae, 18.3 % for peroral administration. Eight hundred and eighteen strains of pathogens were isolated. Gram - positive coccus, gram - negative accounted for 48.0 % and 52.0 %, respectively. All bacterium isolated showed a high resistance against penicillins and cephalosporins. Drug resistance rate of Gram - positive bacteria to penicillin was more than 50.0%, CNS, S. aureus, E. faecalis and S. pneumonic to erythrornycin and cphalosporins was over 71.4 % and 35.7 %. The antibiotic remaining the most active against Gram - positive bacteria was vancomycin. The drug resistance rate against imipenem and ciprofloxacin were lower than 25.0 %. The antibiotic resistance rate of Gram - negative bacteria to ampicillin, cephalosporins and aztreonam were more than 83.0 %, 40.0 % and 32.0 %, to piperacillin and amoxicillin - clavulanic acid were more than 68.9 %, except P. aeruginosa （33.3 %）. The susceptibility of Gram negative bacteria was imipenem （〈 8.4 %, except P. aeruginosa）, much higher than those to ciprofloxacin and amikacin （〈 28.0 %）. Conclusions The rate of antibiotics usage is high in pediatric patients in Changchun. Irrational utilization of antibiotics exists inclinical work. All bacteria isolated showes a high resistance to penicillins and cephalosporins, multi - drug resistance of bacteria is a serious problem in pediatrics. It is very important to monitor the bacteria resistance to antibiotics in pediatric patients, which is helpful to selective antibiotics correctly.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2006年第22期1528-1530,共3页
Journal of Applied Clinical Pediatrics
基金
"十五"国家科技攻关计划项目资助(2004BA720A09-02)
关键词
抗生素
致病菌
耐药性
antibiotic
pathogenic bacteria
drug resistance
