各種儀器、各種藥敏方法所獲監(jiān)測數(shù)據(jù)的共性問題及解決方案

各種儀器、各種藥敏方法所獲監(jiān)測數(shù)

據(jù)的共性問題及解決方案胡付品華山醫(yī)院抗生素研究所主要內(nèi)容共性問題個性問題解決方案主要儀器和方法

主要儀器：15種API、ATB、Microscan、鳳凰、VITEK、創(chuàng)業(yè)軟件、

迪爾、恒星、惠州陽光、復(fù)興佰珞、天地人、

金章、康泰、鑫科、美華

藥敏方法

儀器法

紙片擴(kuò)散法每季度100株以下細(xì)菌數(shù)的醫(yī)院13614162930333738515457726377799891020406080100120H1H2H3H4H5H6H7H8H9

H10

H11

H12

H13

H14

H15

H16

H17

H18

H19真實(shí)數(shù)據(jù)？數(shù)據(jù)處理過程丟失？敷衍了事？統(tǒng)計時報錯：文件名太長

無法統(tǒng)計：API-恒星_阿拉善盟中心醫(yī)院（一季度）.dbf

可以統(tǒng)計：API-恒星_阿拉善盟中心一.dbf實(shí)驗(yàn)室代碼問題

剔除重復(fù)菌株的3大標(biāo)準(zhǔn)

國家代碼、實(shí)驗(yàn)室代碼和住院號重復(fù)菌株導(dǎo)致耐藥菌株的檢出率虛高某醫(yī)院CRE菌株的檢出率：25.7%（432/1683）OrganismNumber

of

isolatesNumber

of

patientsKlebsiella

pneumoniaess.pneumoniae317119Enterobacter

cloacae3010Serratiamarcescens2812Escherichia

coli1811Klebsiella

oxytoca167Enterobacter

aerogenes97Proteusmirabilis85Proteus

rettgeri41Citrobacter

freundii11Morganella

morganii

ss.

morganii11Total432株174株25.7%10.3

%葡萄球菌：關(guān)鍵藥物結(jié)果缺失苯唑西林或頭孢西丁

結(jié)果缺失（141株）金黃色葡萄球菌：苯唑西林和頭孢西丁結(jié)果不一致抗菌藥苯唑西林頭孢西丁抗菌藥苯唑西林頭孢西丁

導(dǎo)致結(jié)果：MRSA

+MSSA

＞總株數(shù)

MRSA：耐藥率降低

MSSA：耐藥率升高株數(shù)耐藥中介敏感793100008787.4012.6株數(shù)耐藥中介敏感8886.4013.69910000糖肽類非敏感的革蘭陽性球菌之：1935株金葡數(shù)據(jù)導(dǎo)出問題？代碼判斷標(biāo)準(zhǔn)株數(shù)耐藥中介敏感-內(nèi)酰胺酶87464.335.7ESBL1730100慶大霉素高濃度S<=512R>=513591.7098.3利奈唑胺_ND30S

>=

211210.8099.2利奈唑胺_NMS<=4 R>=815380.3099.7萬古霉素_ND30S

>=

159900100萬古霉素_NMS<=2 R>=1616770.20.297.1替考拉寧_ND3011

-

133700100替考拉寧_NMS<=8 R>=324291.9098.1糖肽類非敏感的革蘭陽性球菌之：1169株表葡代碼判斷標(biāo)準(zhǔn)株數(shù)耐藥中介敏感-內(nèi)酰胺酶72538.161.9數(shù)據(jù)導(dǎo)出問題？ESBL750100慶大霉素高濃度S<=512R>=513647.8092.2利奈唑胺_ND30S

>=

211000100利奈唑胺_NMS<=4 R>=810180.9099.1萬古霉素_ND30S<=4 R>=3210740.20.199.7萬古霉素_NMS

>=

15900100替考拉寧_ND3011

-

13300100替考拉寧_NMS<=8 R>=325521.62.595.8糖肽類非敏感的革蘭陽性球菌之：989株糞腸+屎腸代碼判斷標(biāo)準(zhǔn)株數(shù)耐藥中介敏感-內(nèi)酰胺酶27413.186.9數(shù)據(jù)導(dǎo)出問題？ESBL600100慶大霉素_NM(高濃度)S<=512

R>=51361149.6050.4慶大霉素_ND120

(高濃度)7

-9

825075慶大霉素_NMS<=4 R>=165479.65.614.8慶大霉素_ND1013

-

14100100利奈唑胺_ND3021

-

221200100利奈唑胺_NMS<=2 R>=870917.691.4萬古霉素_ND3015

-

161200100萬古霉素_NMS<=4 R>=329437.20.192.7替考拉寧_ND3011

-

131200100替考拉寧_NMS<=8 R>=323431.7098.3糖肽類非敏感：必須要確認(rèn)棒極了病歷號科室標(biāo)本類型細(xì)菌VANVAN-MIC確認(rèn)z310951hemseefa160.25hemblefm6vanMz283587hemca

efm6vanMz313404hemthefm6vanMz330779resca

efm6vanMz332461hemblefm6vanMz340140hemvaefm6vanMz345386hemseefm9vanM腸球菌：關(guān)鍵藥“高濃度慶大霉素”藥敏結(jié)果缺失GEH缺失LaboratoryOrganismGENGEHSTHLISeav6LISeav20LISeav17數(shù)據(jù)LISeav6LISeav8LISeava7eava7eava7eav導(dǎo)入錯誤？LISecaa7ecaA06efaA06efaA06efaA06efa肺炎鏈球菌：關(guān)鍵藥青霉素藥敏結(jié)果缺失醫(yī)院住院號細(xì)菌青霉素-ND10青霉素-MIC苯唑西林TSTNZYJXEJXEJXEJXEJXEJXEJXEJXEC23C23C233571260791710002643110002831610002873310007608410010967010012303510016252811196587127212127215129678肺炎鏈球菌肺炎鏈球菌肺炎鏈球菌肺炎鏈球菌肺炎鏈球菌肺炎鏈球菌肺炎鏈球菌肺炎鏈球菌肺炎鏈球菌肺炎鏈球菌肺炎鏈球菌肺炎鏈球菌肺炎鏈球菌6202123初始數(shù)據(jù)只有青霉素KB法結(jié)果未做無法判斷的碳青霉烯類藥敏結(jié)果

451株腸桿菌科細(xì)菌

來自同一家醫(yī)院

判斷標(biāo)準(zhǔn)：≤1g/ml敏感、2

g/ml中介、≥4

g/ml耐藥醫(yī)院

細(xì)菌159159159159159159159159159159亞胺培南-MIC

美羅培南-MIC大腸埃希菌<=4<=4大腸埃希菌<=4<=4肺炎克雷伯菌<=4<=4肺炎克雷伯菌<=4<=4肺炎克雷伯菌<=4<=4產(chǎn)氣腸桿菌<=4<=4產(chǎn)氣腸桿菌<=4<=4產(chǎn)氣腸桿菌<=4<=4產(chǎn)氣腸桿菌<=4<=4黏質(zhì)沙雷菌<=4<=4不同藥敏方法碳青霉烯類結(jié)果的差異

克雷伯菌屬：3463株抗菌藥判斷標(biāo)準(zhǔn)株數(shù)耐藥中介敏感%?亞胺培南_NMS<=1 R>=4237115.90.775.57.9亞胺培南_ND1020

-

224052.70.596.8美羅培南_ND1020

-

223423.50.695.9美羅培南_NMS<=1 R>=421083.225.662.38.8376株亞胺培南耐藥克雷伯菌屬對其他內(nèi)酰胺類的敏感性抗菌藥物株數(shù)耐藥中介敏感%?氨芐西林_NM9095.64.40哌拉西林_NM8491.762.4哌拉西林/他唑巴坦_NM37195.71.92.4頭孢唑啉_NM37099.700.3頭孢呋辛_NM5492.65.61.9頭孢他啶_NM37696.31.12.7頭孢曲松_NM33910000頭孢噻肟_NM7594.72.72.7頭孢吡肟_NM3767911.79.3頭孢西丁_NM4182.94.912.2氨曲南_NM36991.63.831.6厄他培南_NM1080020美羅培南_NM6788.14.57.5540株美羅培南中介克雷伯菌屬對其他內(nèi)酰胺類的敏感性抗菌藥物株數(shù)耐藥中介敏感氨芐西林_NM54095.74.10.2哌拉西林_NM54019.36.174.6哌拉西林/他唑巴坦_NM5402.8295.2頭孢唑啉_NM54060.9039.1頭孢呋辛_NM54046.33.550.2頭孢他啶_NM54011.55.982.6頭孢曲松_NM54029.3565.7頭孢吡肟_NM5400.90.298.9頭孢西丁_NM53954.46.339.3氨曲南_NM54059.40.739.8亞胺培南_NM65033.316.7美羅培南_NM54001000美羅培南中介菌株主要來源

菌株數(shù)：534株

藥敏方法：天地人儀器共性問題個性問題解決方案不同儀器藥敏結(jié)果比較：克雷伯菌屬儀器株數(shù)儀器法-亞胺培南紙片法-亞胺培南API17502.697.4ATB186000100Microscan100100鳳凰2995.7094.3VITEK95640.90.558.6創(chuàng)業(yè)軟件2102098迪爾5152.10.497.5恒星160093.8

6.2無碳青霉烯類藥物結(jié)果惠州陽光復(fù)興佰珞1136.49.154.50 0美羅培南100%中介100天地人534000金章434.79.386溫州康泰1200100鑫科2400100鄭州康泰1800100珠海美華1647.91.890.2R%I%S%？%R%I%S%API：所選藥物太少腸桿菌科細(xì)菌：10個藥。無1、2代頭孢菌素和碳青霉烯類銅綠假單胞菌：6個藥。無碳青霉烯類葡萄球菌：5個藥。無萬古霉素ATB：藥物濃度未覆蓋164株大腸埃希菌抗菌藥判斷標(biāo)準(zhǔn)株數(shù)耐藥中介敏感%?替卡西林S<=16 R>=1281630027.672.4替卡西林/克拉維酸S<=16 R>=1281630071.228.8哌拉西林/他唑巴坦S<=16 R>=1281630094.55.5頭孢呋辛S<=8 R>=321590064.235.8頭孢他啶S<=4 R>=161517.30092.7頭孢吡肟S<=2 R>=161584.40095.6頭孢西丁S<=8 R>=321590085.514.5亞胺培南S<=1 R>=4163000100美羅培南S<=1 R>=4163000100阿米卡星S<=16 R>=641630098.81.2慶大霉素S<=4 R>=161630066.933.1VITEK：部分藥物濃度未覆蓋折點(diǎn)1269株大腸埃希菌頭孢唑啉結(jié)果：

＜4≤4？抗菌藥判斷標(biāo)準(zhǔn)株數(shù)耐藥中介敏感%?備注頭孢唑啉S<=2 R>=884674.6014.810.6未覆蓋4-64頭孢曲松S<=1 R>=466557.9040.61.5覆蓋，導(dǎo)出錯誤？＜8頭孢吡肟S<=2 R>=16101333.28.257.61.1覆蓋，導(dǎo)出錯誤？＜8SMZ-TMPS<=2 R>=4101155043.11.9覆蓋，導(dǎo)出錯誤？≥2創(chuàng)業(yè)軟件：大腸埃希菌代碼為eet非eco代碼細(xì)菌株數(shù)eetEscherichia

coli,

enterotoxigenic

(ETEC)419krnKlebsiella

pneumoniae

ss.

rhinoscleromatis210paePseudomonas

aeruginosa114sauStaphylococcus

aureus

ss.

aureus105abaAcinetobacter

baumannii78eclEnterobacter

cloacae37pmiProteus

mirabilis37sepStaphylococcus

epidermidis32pvuProteus

vulgaris30efaEnterococcus

faecalis26alwAcinetobacter

lwoffii24迪爾：部分藥物濃度未覆蓋折點(diǎn)485株大腸埃希菌

366株銅綠假單胞菌256株金黃色葡萄球菌抗菌藥判斷標(biāo)準(zhǔn)株數(shù)耐藥中介敏感%?濃度設(shè)置CefepimeS<=2 R>=1648546.40053.68/16AztreonamS<=8 R>=324850056.343.74/8抗菌藥判斷標(biāo)準(zhǔn)株數(shù)耐藥中介敏感%?濃度設(shè)置ImipenemS<=2 R>=836629.20070.84/8MeropenemS<=2 R>=836625.70074.34/8抗菌藥判斷標(biāo)準(zhǔn)株數(shù)耐藥中介敏感%NS濃度設(shè)置LinezolidS<=42510098.81.24恒星：部分藥物濃度未覆蓋折點(diǎn)38株大腸埃希菌

7株葡萄球菌抗菌藥判斷標(biāo)準(zhǔn)株數(shù)耐藥中介敏感%?CefuroximeS<=8 R>=323878.92.615.82.6CefepimeS<=2 R>=163871.10028.9AztreonamS<=8 R>=32380018.481.6AmikacinS<=16 R>=64382.62.692.12.6CiprofloxacinS<=1 R>=43873.7023.72.6抗菌藥判斷標(biāo)準(zhǔn)株數(shù)耐藥中介敏感%?VancomycinS<=2 R>=1670057.142.9天地人：美羅培南和頭孢吡肟中介率太高72株大腸埃希菌抗菌藥判斷標(biāo)準(zhǔn)株數(shù)耐藥中介敏感PiperacillinS<=16 R>=1287286.15.68.3Piperacillin/TazobactamS<=16 R>=1287215.35.679.2CefazolinS<=2 R>=87295.804.2CefuroximeS<=8 R>=327288.91.49.7CeftazidimeS<=4 R>=167233.315.351.4CefepimeS<=2 R>=16726.993.10CefoxitinS<=8 R>=327272.25.622.2MeropenemS<=1 R>=4721.498.60AmikacinS<=16 R>=647211.12.886.1GentamicinS<=4 R>=167273.66.919.4鑫科：部分藥物濃度未覆蓋折點(diǎn)

頭孢吡肟儀器濃度范圍：8/16/32

疑問：導(dǎo)出數(shù)據(jù)時，把所有“≤8”的結(jié)果全部導(dǎo)成“8”了？62株腸桿菌科細(xì)菌抗菌藥判斷標(biāo)準(zhǔn)株數(shù)耐藥中介敏感CefazolinS<=2 R>=82556440CefuroximeS<=8 R>=322524472Cefuroxime15

-

173718.9081.1CeftazidimeS<=4 R>=162516084Ceftazidime18

-

2037010.889.2CefotaximeS<=1 R>=42516876Cefepime19

-

2437094.65.4CefepimeS<=2 R>=16258920共性問題個性問題解決方案簡單點(diǎn)擊查看缺項數(shù)據(jù)宏：處理復(fù)雜問題的利器+盡職小秘書非敏感株篩選糖肽類自動匯