Analysis And Research On The Use Of Antibacterial Drugs And Drug Resistance Of Common Pathogenic Bacteria In A Grade A Grade A Children’s Hospital Of Shanxi Province

Objective:To study the use of antimicrobial drugs and the changes of drug resistance of common pathogenic bacteria in a third-grade Class A children’s hospital in Shanxi Province,to explore the correlation between the two,and to analyze the irrational use of antimicrobial drugs in hospitalized patients Provide a reference for the standardized use of antibacterial drugs.Methods: Part I: Analysis of antimicrobial use and drug resistance of common pathogens in a Grade III Grade A children’s hospital in Shanxi Province,2016-20181.Using the limited daily dose(DDD)method recommended by WHO,calculate the frequency of use(DDDs)of each type and each type of antibacterial drugs between 2016 and 2018 according to the year,and statistically organize them with Excel2010 software.DDDs = total consumption of a drug / DDD value of the drug.The DDD value of each antibacterial drug is determined by referring to the "New Edition of Pharmacology"(17th Edition).The new drug is based on the average daily dose for adults specified in the main indications in the instructions.determine.2.Identify the isolated strains with the WITEK2 Compact automatic microbial biochemical identification instrument(French Bio-Merieux).The drug sensitivity test uses Kirby-Bauer and E-test methods.The results were judged according to the 2017 edition of the American Society of Clinical and Laboratory Standards(CLSI)standards.The data results were analyzed with Whonet5.6 software.3.Import the resistance rate of the top five pathogenic bacteria with detection rate,DDDs of all antibacterial drugs included in the susceptibility test and DDDs of various antibacterial drugs into SPSS24.0 statistical software on an annual basis.Pearson correlation analysis was performed,and the difference was statistically significant when P <0.05.Part 2: Analysis of the unreasonable application of antibacterial drugsA total of 4659 cases were discharged from the clinical departments of the children’s hospital from January 2016 to May 2017,and 850 cases were monitored.According to the "Guidelines for Clinical Application of Antibacterial Drugs" and "2012 National Antibacterial Drug Clinical The application of special rectification activities program "," Antimicrobial Drug Clinical Application Management Method " and the hospital’s " Antimicrobial Drug Clinical Application Management System " and other standards analyze the clinical irrational use of antimicrobial drugs in cases,and use Excel2010 software for statistical consolidation.Results: Part I: Analysis of antimicrobial use and drug resistance of common pathogens in a Grade III Grade A children’s hospital in Shanxi Province,2016-20181.The hospital has used 15 antibacterial drugs in three categories for three years,and the top six DDDs of various antibacterial drugs remain unchanged every year.Among them,cephalosporin antibacterial drugs have always ranked first and the usage has increased year by year,and the composition ratio has increased from 51.26% in 2016 to 57.58% in 2018.The hospital mainly uses the second and third generation cephalosporins,and The DDDs of these two types of drugs have also increased year by year.The total DDDs of antimicrobials have increased year by year,with 2017 and 2018 increasing by 1.97% and 4.01% respectively.However,the use of high-level antibacterial drugs carbapenems and glycopeptides in the hospital has decreased year by year.Cephalosporins accounted for more than half of the top ten drugs in the hospital’s antibacterial drugs DDDs,and most of them were second-and third-generation cephalosporins.Azithromycin and cefprozil were ranked in the top two for three consecutive years.2.During the past three years,the hospital received 131,836 specimens and isolated 16,814 pathogenic bacteria with a separation rate of 12.75%.Among them,9256 strains of Gram-negative bacteria,accounting for 55.05%;6591 strains of Gram-positive bacteria,accounting for 39.20%;and 967 strains of other bacteria,accounting for 5.75%.The top five detection rates of pathogenic bacteria in the hospital are Haemophilus influenzae,Streptococcus pneumoniae,Escherichia coli,Staphylococcus aureus,and Klebsiella pneumoniae.The susceptibility test results of the pathogenic bacteria show that Staphylococcus aureus is the most resistant to penicillin G,and the resistance rate is more than 90% for three consecutive years;while it is sensitive to vancomycin,teicoplanin,linezolid Up to 100%;the resistance rate to macrolides is> 60%.The resistance rate of Streptococcus pneumoniae to erythromycin,clindamycin and tetracycline is higher than 90%;the resistance rate to compound sinomenine is> 60%;no resistance to vancomycin and linezolid has been found Strains.The resistance rate of Escherichia coli to ampicillin is> 80%;the resistance rate to ceftriaxone and cefuroxime is> 50%.The resistance rate of Haemophilus influenzae to the compound sulfamethoxazole is the highest,over 60%;the resistance rate to ampicillin is> 55%.The resistance rate of Klebsiella pneumoniae to carbapenem antibacterial drugs is higher than that of the first two bacteria;the resistance rate to cefuroxime and ceftriaxone is maintained at about 60%;Klebsiella pneumoniae and Escherichia coli The resistance rates of the bacteria to ceftriaxone,cefuroxime,and piperacillin are basically the same;the resistance rates to levofloxacin,ciprofloxacin,and gentamicin vary greatly.3.The correlation analysis of the resistance rate of pathogenic bacteria to antibacterial drugs and the DDDs of their respective antibacterial drugs in the hospital showed that the resistance rate of Staphylococcus aureus to ciprofloxacin was significantly positively correlated with its DDDs(r = 0.99,p <0.05).The resistance rate of Klebsiella pneumoniae to meropenem was significantly negatively correlated with its DDDs(r =-0.99,p <0.05);the resistance rate to cefoxitin was significantly negatively correlated with its DDDs(r =-0.99,p <0.05).The correlation analysis results of the resistance rate of pathogenic bacteria to antibacterial drugs and DDDs of various antibacterial drugs show that there is a correlation between the resistance rate of common pathogenic bacteria to a certain antibacterial drug in this hospital and this and other types of antibacterial drugs(p <0.05).Part 2: Analysis of the unreasonable application of antibacterial drugs1.Among the 850 cases monitored,686 cases used antibacterial drugs,and 453 cases were irrational.Among them,there are 34 cases of unreasonable medication in orthopedics,accounting for 7.5% of all cases of unreasonable use of antibacterial drugs,ranking first.Followed by 32 cases of endocrinology,accounting for 7.1%.There were 30 cases in otolaryngology,accounting for 6.6%.2.Among the 686 cases of using antibacterial drugs,there were 453 cases of unreasonable drug use,and the unreasonable use rate was 66.03%.In some cases,there will be multiple types of unreasonable medication,so there are 597 types of unreasonable medication in 453 cases of unreasonable medication.The irrational medication types in the hospital are mainly based on irrational medication frequency,irrational usage and dosage,irrational selection of drug varieties and long preventive medication time,accounting for more than 80% of the total cases of irrational medication types.Conclusion:1.The total use of antibacterial drugs in the hospital is relatively large and increases year by year,especially the second and third generation cephalosporins are the most used,but the use of high-level antibacterial drugs is well controlled,so we must continue to strengthen the Dynamic monitoring of antimicrobial use in hospitals.2.Gram-negative bacteria are the main isolates in this hospital.The main pathogenic bacteria causing infectious diseases in this hospital are Haemophilus influenzae,Streptococcus pneumoniae,Escherichia coli,Staphylococcus aureus and Klebsiella pneumoniae Primary bacteria.The monitoring of drug resistance of these five pathogenic bacteria should be strengthened.3.Through the analysis and research on the resistance of pathogenic bacteria,we can timely understand the changes of the resistance of bacteria to various antibacterial drugs,and provide a reference for the rational selection of antibacterial drugs.4.The resistance of pathogenic bacteria to an antibacterial drug is not only affected by the amount of this type and type of antibacterial drugs,but also by the amount of other types of antibacterial drugs.5.The irrational use of antimicrobial drugs in the hospital is serious and the rate of antimicrobial drugs is high.Corrections should be proposed based on the existing problems in the hospital.At the same time,case review should be strengthened to promote clinical rational drug use.