| Objective:In recent years, with the increasing of antimicrobial agents and the wide applicationof clinical drug resistance of pathogenic bacteria has become a major problem faced by thehuman. Antibacterial drugs is a most widely clinical application of a class of drugs,accounts for about30%to50%of all clinical drugs, due to the large number of use ofantimicrobial agents and bacterial resistance increases. This is mainly caused byunreasonable use of antimicrobial drugs, especially the abuse of antibiotics will lead to alarge amount of drug adverse reactions, drug-induced diseases, life safety threat to patients,also can appear resistant strains produce the serious consequences, such as popular andbring significant difficulties for clinical treatment. A large number of scientific researchresults have been confirmed for a long time, not rational use of antimicrobial agents will befacing mankind is given priority to with drug-resistant bacteria infection of the antibioticera (post-antibiotic era). The dynamic monitoring and pathogen resistance analysis ishelpful for clinical rational use of antimicrobial agents. Therefore, understand the commoncharacteristics of the distribution and drug resistance of gram-negative bacilli, help clinicalrational and safe use of antibiotics, is of great significance to control hospital infection.In this paper, the separation of a tertiary pediatric hospital2013years to cultivateidentification of common pathogenic bacteria and drug resistance of the summary, and thetrend of resistance of the main pathogenic bacteria to do the statistical analysis, hope forclinical provides the experimental basis for the diagnosis and treatment of infectiousdiseases, and the clinical doctor the use of antibiotics and nosocomial infection control toprovide data and support, so as to further promote the reasonable application ofantimicrobial agents.Materials and methods 1. the data source: the monitoring and passive monitoring, using data collected allresistance monitoring data are from a tertiary pediatric hospital reported national bacterialdrug resistance monitoring network original material, the result judgement standardaccording to the clinical laboratory standards (NCCLS) guidelines committee. Basic datafrom January2013to December2013, a children’s hospital of1982strains ofgram-negative bacteria, gram-positive bacteria, drug susceptibility of716strains. WithWhonet5.6software summary analysis.2.Monitoring bacterial species: all bacteria sterile area source of pollution, opensource source of infection pathogenic bacteria and a variety of pathogenic bacteria; Specialresistant bacteria; Specific pathogens. Concrete for main target bacteria: e. coli, withklebsiella pneumoniae, pseudomonas aeruginosa, eosinophilic malt pseudomonas,acinetobacter baumannii, Frau folic acid bacillus, sewer enterobacter, glue Mr Charestbacteria, excrement enterococcus, staphylococcus aureus, streptococcus pneumoniae, atotal of11species of bacteria.3. monitoring target drugs: select monitoring target drugs according to the followingprinciples.1, with reference to internationally accepted principles, and the WHOrecommended bacteria/drug combinations to choose;2, different species of bacteria, drugsensitive test requirement of different drugs;3, every species of bacteria including clinicaleffective antimicrobial drugs as far as possible;4, high value for clinical use but less use ofdrugs is appropriate choice.5, according to the results of drug resistance monitoringadjustment monitoring drug types.4.monitoring results, early warning criteriaTarget bacteria resistant rate more than30%of the antibacterial drugs, it shall timelywarning information about this organization medical personnel;(2) main target bacteriaresistant rate more than40%of the antibacterial drugs, should careful empirical use;(3)the main target bacteria resistant rate more than50%of the antibacterial drugs, drugsensitive test results shall be referred to choose;(4) main target bacteria resistant rate morethan75%of the antibacterial drugs, should be suspended for the clinical application of thetarget bacteria, according to the tracking bacterial drug resistance monitoring results, andthen make a decision whether to restore clinical application.Results and conclusion early warningGram positive bacterial drug resistance monitoring and early warningâ—30%resistant to tetracyclineâ—40%resistance of Ceftriaxone cefazolin gentamicin â—50%resistant to ampicillin/sulbactam oxacillinâ—75%resistance to penicillin and ampicillinStaphylococcus aureus resistance monitoring and early warningâ—30%resistance of Ceftriaxone gentamicin and ampicillin/sulbactamâ—40%resistance. No warning antimicrobial drugsâ—50%resistance. No warning antimicrobial drugsâ—75%resistance to penicillin and ampicillinStreptococcus pneumoniaeâ—30%resistance. No warning antimicrobial drugsâ—40%resistance. No warning antimicrobial drugsâ—50%resistant to penicillin Gâ—75%resistant to cefoxitin oxacillinEnterococcus faeciumâ—30%resistance. No warning antimicrobial drugsâ—40%resistance. No warning antimicrobial drugsâ—50%resistant to cefazolinâ—75%G levofloxacin resistant penicillin gentamicin tetracycline ampicillinGramnegative bacteria drug resistance monitoring and early warningâ—30%resistant to ceftazidime gentamicin compound sulfamethoxazoleâ—40%resistant to cefoxitin cefepime tetracycline aztreonam amoxicillin/clavulanicacidâ—50%resistant to piperacillin ceftriaxone and cefotaximeâ—75%of ampicillin resistance to ampicillin/sulbactam cefazolinEscherichia coliâ—30%resistant to levofloxacinâ—40%resistance No warning antimicrobial drugsâ—50%cefazolin and cefotaxime resistance of Ceftriaxoneg cefepime tetracyclinegentamicin cotrimoxazole aztreonamâ—75%resistant to piperacillin ampicillin/sulbactam ampicillinKlebsiella pneumoniaeâ—30%resistance No warning antimicrobial drugsâ—40%resistant to ceftazidime tetracycline and cotrimoxazoleâ—50%resistant to cefazolin cefotaxime ceftriaxone cefepime Qu Songâ—75%resistance to cefazolin and piperacillin ampicillin/sulbactam ampicillin Citrobacter freundiiâ—30%resistant to cefotaxime and ceftazidime and cefepime ticarcillin/clavulanicacid gentamycin tetracycline and cotrimoxazoleâ—40%resistance of Ceftriaxoneâ—50%resistant to piperacillin amoxicillin/clavulanic acidâ—75%resistant to cefoxitin cefazolin ampicillinSerratia marcescensâ—30%resistance. No warning antimicrobial drugsâ—40%cefotaxime resistanceâ—50%resistant ceftazidime, piperacillin/tazobactam piperacillin aztreonamâ—75%resistant to amoxicillin/clavulanic acid ampicillin and tetracyclineEnterobacter cloacaeâ—30%resistance to ticarcillin/clavulanic acidâ—40%resistance ceftriaxone cefotaxime and ceftazidime aztreonamâ—50%resistant to piperacillinâ—75%cefazolin, cefoxitin resistant to ampicillin/sulbactam amoxicillin/clavulanicacid ampicillinCitrobacter freundiiâ—30%resistant to cefotaxime and ceftazidime and cefepime ticarcillin/clavulanicacid gentamycin tetracycline and cotrimoxazoleâ—40%resistance of Ceftriaxoneâ—50%resistant to piperacillin amoxicillin/clavulanic acidâ—75%resistant to cefoxitin cefazolin ampicillinSerratia marcescensâ—30%resistance. No warning antimicrobial drugsâ—40%cefotaxime resistanceâ—50%resistant ceftazidime, piperacillin/tazobactam piperacillin aztreonamâ—75%resistant to amoxicillin/clavulanic acid ampicillin and tetracyclinePseudomonas aeruginosaâ—>30%resistance to ticarcillin/clavulanic acid aztreonamâ—>40%cefotaxime resistance of piperacillinâ—>50%resistance of Ceftriaxoneâ—>75%resistant to cefazolinPseudomonas maltophilia â—>30%resistance No warning antimicrobial drugsâ—>40%resistance. No warning antimicrobial drugsâ—>50%resistant to ceftazidimeâ—>75%resistance. No warning antimicrobial drugsBauman Acinetobacterâ—>30%resistance ceftriaxone and cefotaxime and ceftazidime meropenemgentamicinâ—>40%resistance to ticarcillin/clavulanic acid cefepimeâ—>50%resistant to piperacillinâ—>75%resistant to cefazolinAccording to the Ministry of Health Order (No.84),"clinical use of antibioticsmanagement approach" requirement, the main objective of bacterial resistance rates ofmore than30%of the antimicrobial agents, shall promptly notify the agency early warninginformation medical personnel;(b) The main objective of bacterial resistance rate of morethan40%of the drug antimicrobial drugs, medication should be carefully experience;(c)the main objective of bacterial resistance rates of more than50%of the antimicrobialagents, reference susceptibility test results should be chosen;(d) the main objective ofbacterial resistance rates of over75%antibacterial drugs, should be suspended for theclinical application of this target bacteria, according to tracking antimicrobial resistancemonitoring results, and then decide whether to resume clinical application. |
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