Analysis Of Antimicrobial Use In Patients With NI In Tianjin Orthopaedics Hospital And Relationship Between Antimicrobial Use And Resistance

Antibiotics have contributed to treat infectious diseases,however, antibiotic-resistance bacterial pathogens haveincreased and spread rapidly with the antimicrobial abuse, itmade the treatment of infections dieases become verydifficulty. It lead to situation of the antibiotic crisis onmedical science at present. The irrationnal usage ofantimicrobial agents caused increasing of adverse drug reactionand bacterial resistance, so lead to nosocomial infection andfailure of treatment, lt is very important to find out thesituation of antimicrobial use, study distribution of pathogensand factors of drug-resistance to rational antimicrobial use. TheTianjin Orthopaedics Hospital is the biggest orthopedics specialhospital. The numbers of patients and consumption of theantimicrobial were huge, so the situation of the antimicrobialuse, distribution of pathogens and drug resistant wererepresentative.Part oneAn investigation and analysis of antimicrobial usein patient with nosocomial infection in TianjinOrthopedics HospitalTo analyse the rationality of antimicrobials use for the prophylaxis and treatment, study the correlation betweennosocomial infection and antimicrobialuse, and improve therational usage of antimicrobial. By taking retrospectivestudy, selected the patients with nosocomial infection afterⅠ-type operation from 2002 to 2006 as models. The information ofpatients, disease, operations, and antimicrobials use werecollected. All of information was put into computer and the datawere calculated with EXCEL, in order to analyse the situation ofantimicrobials use, trend and rationality.The top six kinds of pathogens of nosocomial infection werestaphylococcus aureus(25.69%),coagulase negative staphylo-coccus(20.18%),acinetobacter(15.60%),pseudomonas aerugino-sa(14.68%),escherichia coli(10.09%),enterococcus faecalis(9.17%).There was the irrational prophylaxis use in 85.72%cases, such as the use of third-generation cephalosporins(68%),escessive dosage(60%),long period of the prophylaxisuse(55%),the irrational combined use(20%) and unsuitablefrequency(12%).The most antimicrobial agents used in patientswith nosocomial infection was 10 kinds of them, average 3.59. Themain antimicrobial used after nosocomial infection wascephalosporins, the top one was cefoperazone/sulbactam. The DUIof six kinds of antimicrobials including gentamycin, aztreonametc was close 1.00, ten kinds of antimicrobials includingetimicin, cefuroxime, etc was more exceed 1.00, mezlocillin andamikacin was more less 1.00. None of relative value of amount ofmoney and serial number of DDDs was exceed 5,only one was less 0.5.The period of antimicrobial use not according to susceptibilitytest was longer than according to it. The former was 11 days andthe latter was 9 days.The pathogens ofnosocomial infection are staphylococcus aureus mainly, but proportion of the gram-negative bacteria is increasing.Theproblems of antimicrobials prophylaxis use during surgicalprocedures include not to use first-line antimicro-bials, excessive dosage, long course and unsuitable time ofinitial using. The antimicrobials used to nosocomial inaction havesome problems, such as unnecessarily using,excessive dosage,withoutevidence and not cheap.Part two Relationship between antimicrobial use and resistanceamong clinical strains in the deparment of orthopaedicsTo investigate the correlation between the use ofantimicrobialsand resistance among clinical isolates of bacteria in thedepartment of orthopaedics. The use of antimicrobial wasexpressed as a mumber of DDD per 100pt-days, in order to avoideffect of the number changing of patients. To study thecorrelation between one quarterly consumpion of antimicrobialand resistance rates of common bacterial that quarter and nextquarter, get r-value and test it with t-test. Antimicrobial agentsinclude ceftazidime, ceftriaxone, amikacin, gentamycin,ciprofloxacin,cefoperazone/sulbactam,levofloxacin,cefotaxime,etimicin, aztreonam. Bacterial include staphylococcus aureus,coagulase negative staphylococcus, acinetobacter, pseudomonasaeruginosa, escherichia coli, enterococcus faecalis.The consumption of ceftazidime was significantly associatedwith resistance of pseudomonas aeruginosa to it in nextquarter. The consumption of ceftazidime was significantlyassociated with resistance of pseudomonas aeruginosa to otherseven kinds of bacteria includingefotaxime, aztreonam, cefopera-zone/sulbactam etc. in next quarter(p＜0.05).The correlation was not statistically significant with ceftriaxone and gentamycin.The correlation is more statistically significant between theconsumption of the most antimicrobial agents and resistance ofpseudomonas aeruginosa to them in next quarter than thatquarter. The resistence among pseudomonas aeruginosa strainsemerged with ceftazidime is multiresistant, so mechanism of drugresistance of pseudomonas aeruginosa is complicated. The studydemonstrates ceftazidime is only one of third-generationcephalosporins needed to be limited, because there is a specificcorrelation between ceftazidime use and multiresistance ofpseudomonas aeruginosa.