| Background The advent of the"antibiotics era"came with two historical events--Fleming discovered penicillin in 1929 and it worked amazingly after applied clinically by Florey and Chain, which greatly prolonged human being's life. But soon, the units of penicillin and other antibiotics increased along with their wide use in clinic, which made people realize bacteria's resistance to drugs and paid more and more attention to this problem. Nowadays,"post-antibiotics era"has been used to underline the severity. Moreover,bacteria could produce resistance to several antibiotics structurally unrelate, that is, multiple antibiotics resistance (MAR). Bacteria's resistance especially multi-drug resistance has been a heated topic at present in the world.Significance Kollef .MH proposed each ICU ward should be cleared about the infection materials of bacterium epidemiology in this area,as well as medicine sensitive and so on for preventing the antibiotics abusiveness and enhancing the activeness of antibiotics; If not clear the bacterium epidemiology material this region and use antibiotics by empirical, we should not use the antibiotics. It is in the critical moment for the infected patients in ICU, If wait passively the bacteriology material and the medicine sensitive result, It can be delayed for the opportunity of treating and executes with difficulty best. therefore understood bacterium epidemiology and the medicine sensitive material in ICU may help doctor to select the empirical antibiotics reasonably. By attacking fiercely, we can control the infection rapidly and enhance the rescue success ratio.Objective Establish critically the monitor database of ICU ward usage and the nosocomial bacterial infection and analysis the research of the change of the bearing bacteria and syndrome differentiation of TCM in ICU ward near 3 years, It provides the evidence of reducing the level of bearing the medicine and selecting the antibiotic reasonably.Methods By using the investigation method of reviewing clinical epidemiology, collect all in-patient's medical record during March 2005 to February 2008 in ICU of Chinese Medicine Academy of Science Guang'an Men Hospital and integrate the antibiotic cases of illness, which have the history of infective medical and (or) used the antibiotic in the courtyard, and then the material is input the ACCESS database, and analysis infectious disease type, the bacterium distribution, the rate of bearing the medicine and the Chinese medicine symptom change.Results The patients in ICU mostly merge many kinds of foundation disease and live in hospital for a long time , the conditions are seriously injured. So the infection percentage is high and the infectious disease mostly belong to the respiratory tract infection. The chronic blocking pulmonary tuberculosis occupies above 5 tenths. The infection bacterium, situated the pseudomonas aeruginosa (38.3%), staphylococcus aureus(18%), acinetobacter baumannii(17%)in turn, are G- primarily. Candida albicans yearly arrange at fourth, but the infective ratio is dropping year by year; The ratio of Pseudomonas aeruginosa rises violently in 2006 and returns to the level of 2005 in 2007; In 2007 the ratio of the acinetobacter baumannii rises, and achieves the most bacterium.G+ sensitive rate of the top three is vancomycin (91.58%), nitrofurantoin result (77.23%), sulfonamides (64.85%), and the remaining antibiotics do not reach the rate of 20 percent for three years; G- sensitive rate of the top three is amikacin (71.89%), piperacillin /tazobactam(63.78%), cefoperazone /sulbactam(61.89%), The sensitive rate of imipenem decreased year after year, cefepime failed to reflect the effectiveness of four generations of cephalosporins; The sensitive rates of the fluconazole and voriconazole were more than 80 per cent better and have the clinical effect in the result of fungi.Pseudomonas aeruginosa are the largest number of all Pathogens, The sensitive rates of amikacin,the enzyme inhibitor with penicillin and cephalo-sporins are above 70%, but three years monitoring results discovered that the sensitive rates of amoxicillin /clavulanic acid, ceftriaxone, ceftazidime, ceftiofur oxime, cefotaxime, co-trimoxazole, nitrofurantoin, aztreonam and tetracycline are less than 5%, So we should use less; The sensitive rates of cefepime, nitrofurantoin because and aztreonam decreased. The number of Staphylococcus aureus was second, and the sensitive rate to vancomycin, sulfonamides, nitrofurantoin was more than 90% for the last two years, with the rapid growing rate of MRSA training, Clinical drug is used less; the past three years ,the number of the acinetobacter baumanni is the fastest-growing. in 2007 it is more than Pseudomonas aeruginosa and the most positive pathogens. Since 2007 ICU producd ESBLs-ing strains of acinetobacter baumannii, almost all antibiotics are resistant for it. therefore, it should be aroused our full attention. In ICU the sensitive rate of Klebsiella was higher than other pathogens. All sensitivity rates of drug were more than 50%, and 100% sensitive to imipenem. The rates of cephalosporins ceftiofuroxime, cefotaxime, ciprofloxacin and levofloxacin decreased year after year, it should be noticed the clinical choice. For the majority of antibiotics, the rate of colon Escherichia coli nearly three years was rapid increased in sensitivity. However, the sensitivity rate of nitrofurantoinhas reduced to around 70%; vancomycin on the Enterococcus faecalis was 100% sensitive, The clinical effect was good. But other antibiotics were less sensitive, which, with the exception of penicillin, ampicillin sulfonamides and nitrofurantoin, were due to below 12%; The sensitive rate of candida albicans on voriconazole was 100% sensitive, and on 5-fluorocytosine, fluconazole and other were above 80% sensitive. but in recent years, ICU was found the sophie's candida aeromonas jundeng with natural resistance to drugs such as fluconazole grams. Sophie's candida aeromonas Jundeng should arouse attention!The TCM-syndrome of the pathogen, infected, was similar, but also has their own characteristics. From the general speaking, the statistics of this research was used for the vast majority of sputum specimens, and the incidence is severe pneumonia or COPD with pulmonary infection. Therefore phlegm pulmonary resistance is the basic syndrome type, but this statistics had many patients of the tracheal intubation, So the Pseudomonas aeruginosa, Staphy-lococcus aureus, Enterobacteriaceae, and Acinetobacter baumannii are the most common fungal nosocomial pathogens. with critical condition and upright ness damaged, the main characteristics of Qi-Yin injury is quite common.Conclusions The emergence and development of the bacteria-resistance are influencd by a variety of factors. The study found that consumption of drug had a large and complex relationship with the resistant-bacteria. Most reports indicated that the multiple antibiotics rate has been increasing in the domestic clinical isolates of bacterial. For reducing the rate of bacterial resistance, clinicians should rationally use of antibioticsand pay attention to the inspection rate of bacterial culture and identification and susceptibility to bacterial result, We should use drug experiencely according to the results of previous years and then timely adjust programme after the results coming, for avoiding the irrational use of antibiotics. In addition we should give fully play to the advantages of TCM.In view of the syndrome of infected persons was syndrome of phlegm heat retention mainly, We create the syndrome of Yu programme at first. According to the similar between bacterial resistance mechanism and "Fuxie" theory of TCM, we make "Fuxie" as a breakthrough point, with the clinical experience of Pro. Qi Wen-sheng, We use Xin Jia Da Yuan decoction in ICU, and make efforts for reducing the advantages of antibiotic resistance by cure Yu, strengthen the body and centralizer. |
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