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目的:评价抗菌药物临床应用专项整治活动对我院抗菌药物合理应用及减缓细菌耐药性的效果。方法:按抗菌药物专项整治前后3年进行分组,比较两组抗菌药物临床应用相关指标及细菌耐药性等数据。结果:专项整治后,住院患者抗菌药物使用率从77%降至55%,抗菌药物使用强度从86 DDDs/(100人·d)降至39 DDDs/(100人·d),Ⅰ类切口手术患者预防使用抗菌药物比例从98%降至27%,门、急诊患者抗菌药物处方比例分别从36%、49%降至12%、23%。微生物检验标本送检率从20.2%升至38.8%,无菌部位标本送检率从29.8%升至37.6%。真菌检出率从14.4%降至11.2%。大肠埃希菌、肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)菌株的检出率分别从57.3%、43.2%降至51.3%、36.1%。居前5位细菌的多重耐药菌总检出率从48.4%降至29.3%,但2014年多重耐药鲍曼不动杆菌检出率升至80.7%,鲍曼不动杆菌对亚胺培南、美罗培南的耐药率分别达到66.9%、69.1%。肺炎克雷伯菌对第一、二、三代头孢菌素类、哌啦西林/他唑巴坦、亚胺培南、美洛培南的耐药性有增加趋势。结论:抗菌药物专项整治活动效果明显,提高了医院抗菌药物临床应用的管理水平,但细菌耐药形势仍然严峻,需要建立抗菌药物临床应用长效管理机制,加强病原学检查和细菌耐药性监测,严格执行手卫生和消毒隔离制度。
OBJECTIVE: To evaluate the rational use of antimicrobial agents and the antimicrobial resistance in clinical practice of antimicrobial agents. Methods: According to the special treatment of antimicrobial agents for 3 years before and after grouping, comparing the two groups of antimicrobial agents clinical application of relevant indicators and bacterial resistance and other data. Results: After special treatment, the inpatient antimicrobial use rate dropped from 77% to 55%, and the strength of antimicrobial use dropped from 86 DDDs / (100 persons · d) to 39 DDDs / (100 persons · d) The proportion of patients using antimicrobial drugs was reduced from 98% to 27%, and the proportion of prescription antibacterials in door and emergency patients dropped from 36% and 49% to 12% and 23% respectively. The rate of delivery of microbial test specimens increased from 20.2% to 38.8%, and that of sterile parts increased from 29.8% to 37.6%. The detection rate of fungi decreased from 14.4% to 11.2%. The detection rates of Escherichia coli and Klebsiella pneumoniae producing extended-spectrum β-lactamase (ESBLs) strains decreased from 57.3% and 43.2% to 51.3% and 36.1%, respectively. The overall prevalence of multi-drug resistant bacteria in the top 5 bacteria dropped from 48.4% to 29.3%, but the detection rate of multidrug-resistant Acinetobacter baumannii increased to 80.7% in 2014. Acinetobacter baumannii In South and Meropenem, the resistance rates reached 66.9% and 69.1% respectively. Klebsiella pneumoniae increased the resistance of the first, second and third generation cephalosporins, piperacillin / tazobactam, imipenem and meropenem. Conclusion: The special rectification activities of antimicrobial drugs have obvious effect and improve the management level of clinical application of antimicrobial drugs in hospitals. However, the drug resistance situation of the bacteria is still grim. It is necessary to set up a long-term management mechanism of clinical application of antimicrobial agents, and strengthen the etiological examination and bacterial drug resistance monitoring Strict implementation of hand hygiene and disinfection and isolation system.