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目的了解在抗菌药物整治活动和国际医疗卫生机构认证标准(JCI)认证前后医院内氟喹诺酮类用药合理性的改善情况。方法回顾性调查2009—2013年鲍曼不动杆菌(Ab)、铜绿假单胞菌(Pa)、肺炎克雷伯菌(Kp)和大肠埃希菌(Ec)的耐药率和抗菌药物使用强度,以及住院患者左氧氟沙星的用药合理性及氟喹诺酮类的用药差错。结果抗革兰氏阴性细菌药物使用强度呈下降趋势。Ab、Kp、Ec对环丙沙星和左氧氟沙星耐药率、Pa对左氧氟沙星的耐药率均持续下降。氟喹诺酮类的使用强度逐年下降,与4种细菌对环丙沙星、左氧氟沙星、哌拉西林钠他唑巴坦钠的耐药率、Pa对头孢他啶、头孢吡肟、亚胺培南和美罗培南的耐药率显著正相关。与左氧氟沙星和莫西沙星不同的是,环丙沙星使用强度与细菌耐药性相关性不强。左氧氟沙星静脉给药与口服使用量的比值显著降低(P<0.05),基于肌酐清除率设计剂量的病历占比明显增加(P<0.05)。97.2%的氟喹诺酮类用药差错被药师前瞻性有效拦截。结论氟喹诺酮类抗菌药的用药规范性和合理性有明显提升。氟喹诺酮类与其他抗菌药在细菌耐药性方面的影响存在复杂的关系。控制氟喹诺酮类抗菌药的过度使用,可积极影响细菌对其他抗菌药的耐药性,但不同氟喹诺酮类药物对细菌耐药性的影响存在差异。
Objective To understand the improvement of the rational use of fluoroquinolones in hospitals before and after the antimicrobial remediation activities and accreditation by the International Medical and Health Institutions (JCI). Methods The rates of resistance and antimicrobial use of Acinetobacter baumannii (Pa), Pseudomonas aeruginosa (Pa), Klebsiella pneumoniae (Kp) and Escherichia coli (Ec) from 2009 to 2013 were retrospectively reviewed. Intensity, as well as the rational use of levofloxacin in hospitalized patients and fluoroquinolone medication errors. Results The intensity of anti-Gram-negative bacteria drug use showed a decreasing trend. Ab, Kp, Ec resistance to ciprofloxacin and levofloxacin, Pa resistance to levofloxacin continued decline. The use intensity of fluoroquinolones decreased year by year, and the resistance rates of four bacteria to ciprofloxacin, levofloxacin and piperacillin-tazobactam sodium, Pa to ceftazidime, cefepime, imipenem and meropenem Drug resistance was significantly and positively correlated. Unlike levofloxacin and moxifloxacin, ciprofloxacin use strength and bacterial resistance is not strong correlation. The ratio of intravenous to oral administration of levofloxacin was significantly lower (P <0.05), and the proportion of medical records based on the designed dose of creatinine clearance was significantly increased (P <0.05). 97.2% of fluoroquinolone medication errors were prospectively and effectively intercepted by pharmacists. Conclusions Fluoroquinolone antibacterials have been significantly improved in its standardization and rationality. There is a complex relationship between the effects of fluoroquinolones and other antibacterials on bacterial resistance. Control over the use of fluoroquinolone antibacterials can positively influence the bacterial resistance to other antibacterials, but the influence of different fluoroquinolones on bacterial resistance is different.