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专项整治后我院住院患者抗菌药物使用量与大肠埃希菌耐药率的变化及其相关性分析
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| 篇名： | 专项整治后我院住院患者抗菌药物使用量与大肠埃希菌耐药率的变化及其相关性分析 |
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| 摘要： | 目的：为指导临床抗菌药物合理应用提供参考。方法：从全国抗菌药物临床应用监测网提取我院2012年1月－2016年12月（抗菌药物专项整治后）住院患者的抗菌药物使用相关数据，统计各类抗菌药物及抗大肠埃希菌（E. coli）药物的用药频度（DDDs）；统计同期E. coli的检出、产超广谱β-内酰胺酶（ESBLs）及耐药情况；采用Pearson检验考察抗菌药物DDDs与E. coli耐药率的相关性。结果：2012－2016年，我院住院患者使用DDDs最高的抗菌药物类别为头孢菌素类，其次为头霉素类和大环内酯类。抗菌药物的总DDDs基本呈下降趋势，但2016年略有反弹。2013年以后，大部分类别抗菌药物的DDDs与总DDDs的变化趋势基本一致；而青霉素类与β-内酰胺酶抑制剂的复合制剂、头霉素类、碳青霉烯类、糖肽类药物的DDDs基本呈上升趋势。2012年，第二代头孢菌素是头孢菌素类药物中DDDs最高的一类；而从2013年起，第一代头孢菌素成为该类药物中DDDs最高的一类。抗E. coli药物包括哌拉西林钠他唑巴坦钠、头孢他啶、头孢曲松、头孢吡肟、头孢西丁、氨曲南、美罗培南、庆大霉素、左氧氟沙星；2012年DDDs最高的是头孢曲松，而2016年则是头孢西丁；氨曲南的使用量减少最明显。2012－2016年，分别检出E. coli 110、132、104、131、243株；细菌产ESBLs率有所下降，分别为56.6％、57.0％、50.6％、48.4％、45.0％。E. coli对氨苄西林、头孢唑林、头孢曲松、复方磺胺甲噁唑的耐药率较高，对哌拉西林钠他唑巴坦钠、头孢西丁、亚胺培南、阿米卡星的耐药率较低；对哌拉西林钠他唑巴坦钠的耐药率与头孢曲松、氨曲南、庆大霉素、左氧氟沙星、头孢菌素类（第一、三代头孢菌素）、四环素类、喹诺酮类药物的DDDs和总DDDs呈正相关（r为0.880～0.929，P＜0.05）；对头孢他啶的耐药率与头孢曲松、氨曲南、庆大霉素、左氧氟沙星、头孢菌素类（第一、二、三代头孢菌素）、四环素类、喹诺酮类药物的DDDs和总DDDs呈正相关（r为0.888～0.991，P＜0.05）；对头孢吡肟的耐药率与氨基糖苷类药物的DDDs呈正相关（r＝0.901，P＜0.05）；对庆大霉素的耐药率与青霉素类与β-内酰胺酶抑制剂的复合制剂、头孢吡肟的DDDs呈负相关（r分别为－0.914、－0.921，P＜0.05）；对亚胺培南的耐药率与头孢曲松、氨曲南、庆大霉素、左氧氟沙星、头孢菌素类（第一、二、三代头孢菌素）、氨基糖苷类、四环素类、喹诺酮类药物的DDDs和总DDDs呈负相关（r为－0.994～－0.878，P＜0.05）；对所有抗E. coli药物的耐药率均与其各自的DDDs无关（P＞0.05）。E. coli产酶率与对庆大霉素的耐药率呈正相关（r＝0.955，P＜0.05），而均与对其他药物的耐药率或DDDs无关（P＞0.05）。结论：经抗菌药物专项整治后，我院住院患者抗菌药物的总使用量基本呈下降趋势，结构亦有较大变化；耐药情况虽较为严峻，但细菌产酶率有所下降。临床仍应结合细菌耐药情况监测数据、药敏试验结果、抗菌药物使用量与耐药率的相关性等因素，慎重选择敏感的抗菌药物，以减少细菌耐药的发生。 |
| ABSTRACT： | OBJECTIVE： To provide reference for rational use of antibiotics in clinic. METHODS： The quarterly information about the consumption of antibiotics in inpatients of our hospital during Jan. 2012-Dec. 2016 were collected from Center for Antibacterial Surveillance. DDDs of various antibiotics and Escherichia coli were analyzed statistically； the detection of E. coli， producing ESBLs and drug resistance during the same period were also analyzed statistically. The correlation between DDDs of antibiotics and resistance rate was investigated by Pearson test. RESULTS： During 2012-2016， DDDs of cephalosporins was the highest in inpatients of our hospital， followed by cephamicins and macrolides. Total DDDs of antibiotics showed a decreasing trend and a slight rebound in 2016. After 2013， DDDs of most antibiotics were basically same to the change of total DDDs. However， DDDs of compound preparations of penicillin and β-lactamase inhibitors， cephalomycin， carbapenems and glycopeptides showed an upward trend. In 2012， DDDs of second-generation cephalosporin was the highest among cephalosporins； since 2013， DDDs of first-generation cephalosporin was the highest in this category. Anti-E. coli drugs included piperacillin sodium and tazobactam sodium， ceftazidime， ceftriaxone， cefepime， cefoxitin， aztreonam， meropenem， gentamicin， levofloxacin. Among anti-E. coli drugs， DDDs of cefatriaxone was the highest in 2012， while that of cefoxitin was the highest in 2016； the consumption of aztreonam decreased most obviously. During 2012-2016， 110， 132， 104， 131， 243 strains of E. coli were detected in our hospital respectively. The rate of producing ESBLs decreased to 56.6％， 57.0％， 50.6％， 48.4％， 45.0％. E. coli was highly resistant to ampicillin， cefazolin， ceftriaxone and compound sulfamethoxazole， while poorly resistant to piperacillin sodium and tazobactam sodium， cefoxitin， imipenem and amikacin. Resistance rate of piperacillin sodium and tazobactam sodium was positively correlated with DDDs of ceftriaxone， aztreonam， gentamicin， levofloxacin， cephalosporins （first-， third-generation cephalosporins）， tetracyclines， quinolones and total DDDs （r were 0.880 to 0.929，P＜0.05）. Resistance rate of ceftazidime was positively correlated with DDDs of ceftriaxone， aztreonam， gentamicin， levofloxacin， cephalosporins （first-，second-， third-generation cephalosporins）， tetracyclines， quinolones and total DDDs （r were 0.888 to 0.991， P＜0.05）. Resistance rate of cefepime was positively correlated with DDDs of aminoglycosides（r was 0.901，P＜0.05）. Resistance rate of gentamicin was negatively correlated with DDDs of compound preparations of penicillin and β-lactamase inhibitors， cefepime（r were －0.914，－0.921，P＜0.05）. Resistance rate of imipenem was negatively correlated with DDDs of ceftriaxone， aztreonam， gentamicin， levofloxacin， cephalosporins （first-，second-， third-generation cephalosporins）， aminoglycosides， tetracyclines， quinolones and total DDDs（r were －0.994 to －0.878，P＜0.05）. Resistance rates of anti-E. coli drugs were all independent from their DDDs （P＞0.05）. The rate of E. coli producing enzyme was positively correlated with resistance rate of gentamicin（r was 0.955，P＜0.05）， while was independent from resistance rate or DDDs of other drugs （P＞0.05）. CONCLUSIONS： After antibiotics special rectification， total consumption of antibiotics in inpatients of our hospital show a downward trend， and the varieties also change greatly. Although drug resistance is serious， the rate of producing enzyme is decreasing. Antibiotics should be selected carefully according to the monitoring data of bacterial resistance， drug sensitivity test results， the correlation between the consumption of antibiotics and resistance rate so as to reduce the occurrence of bacterial resistance. |
| 期刊： | 2018年第29卷第2期 |
| 作者： | 奚彩萍，陶文婷，承晓京，李敏，张焱 |
| AUTHORS： | XI Caiping，TAO Wenting，CHENG Xiaojing，LI Min，ZHANG Yan |
| 关键字： | 抗菌药物；用药频度；大肠埃希菌；耐药率；相关性 |
| KEYWORDS： | Antibiotics； DDDs； Escherichia coli； Resistance rate； Correlation |
| 阅读数： | 311 次 |
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