医院肠杆菌科细菌耐药率与抗菌药使用强度的相关性

Correlation between drug resistance rate of Enterobacteriaceae bacteria and intensity of antimicrobial use in hospitals

目的分析近7年大肠埃希菌及肺炎克雷伯菌耐药率与抗菌药物使用强度(antibiotics use density,AUD)的相关性,为临床合理使用抗菌药物提供参考。方法回顾性分析该院2016—2022年大肠埃希菌及肺炎克雷伯菌的耐药率与同期主要抗菌药物的AUD,采用Pearson相关性分析法分析两者的相关性。结果大肠埃希菌对对哌拉西林/他唑巴坦的耐药率与头孢呋辛的AUD呈正相关(P<0.05);对头孢吡肟的耐药率与头孢西丁、氨曲南的AUD呈正相关(P<0.01、P<0.05);对头孢西丁的耐药率与头孢西丁的AUD呈正相关(P<0.05);对亚胺培南的耐药率与头孢哌酮/舒巴坦、阿米卡星的AUD呈正相关(P<0.01)。肺炎克雷伯菌对阿莫西林/克拉维酸的耐药率与头孢西丁、氨曲南的AUD呈正相关(P<0.01);对哌拉西林/他唑巴坦的耐药率与头孢西丁的AUD呈正相关(P<0.05),对头孢噻肟的耐药率与阿莫西林/克拉维酸的AUD呈正相关(P<0.01);对头孢吡肟的耐药率与头孢西丁、左氧氟沙星的AUD呈正相关(P<0.05);对阿米卡星的耐药率与头孢他啶、头孢噻肟、亚胺培南的AUD呈正相关(P<0.01、P<0.05)。大肠埃希菌对哌拉西林/他唑巴坦的耐药率与头孢唑啉的AUD呈负相关(P<0.05);对头孢唑啉的耐药率与头孢他啶、头孢噻肟的AUD呈负相关(P<0.05);对头孢吡肟的耐药率与哌拉西林/他唑巴坦、头孢噻肟的AUD呈负相关(P<0.05);对头孢西丁的耐药率与头孢噻肟的AUD呈负相关(P<0.05);对亚胺培南的耐药率与阿莫西林/克拉维酸的AUD呈负相关(P<0.05)。肺炎克雷伯菌对阿莫西林/克拉维酸的耐药率与哌拉西林/他唑巴坦的AUD呈负相关(P<0.05);对头孢西丁的耐药率与哌拉西林/他唑巴坦的AUD呈负相关(P<0.05)。结论大肠埃希菌及肺炎克雷伯菌的耐药率与多种抗菌药物的AUD相关,应加强抗菌药物的合理管控,延缓细菌耐药的发生。

Objective To analyze the correlation between the resistance rate of Escherichia coli and Klebsiella pneumoniae and antibacterial use density(AUD)in a hospital in the past 7 years,so as to provide reference for the rational use of antibiotics in clinical practice.Methods A retrospective analysis was conducted on the drug resistance rates of Escherichia coli and Klebsiella pneumoniae in the hospital from 2016 to 2022,as well as the AUD of major antibacterial drugs during the same period.Pearson correlation analysis was used to analyze the correlation.Results The resistance rate of Escherichia coli to piperacillin/tazobactam was positively correlated with cefuroxime AUD(P<0.05);The resistance rate to cefepime was positively correlated with the AUD of cefoxitin and amtreonam(P<0.01,P<0.05);The resistance rate to cefoxitin was positively correlated with cefoxitin AUD(P<0.05);The resistance rate to imipenem was positively correlated with cefoperazone/sulbactam and amikacin AUD(P<0.01).The resistance rate of Klebsiella pneumoniae to amoxicillin/clavulanic acid was positively correlated with the AUD of cefoxitin and amtreonam(P<0.01);The resistance rate to piperacillin/tazobactam was positively correlated with cefoxitin AUD(P<0.05),and the resistance rate to cefotaxime was positively correlated with amoxicillin/clavulanic acid AUD(P<0.01);The resistance rate to cefepime was positively correlated with the AUD of cefoxitin and levofloxacin(P<0.05);The resistance rate to amikacin was positively correlated with the AUD of ceftazidime,cefotaxime,and imipenem(P<0.01,P<0.05).The resistance rate of Escherichia coli to piperacillin/tazobactam was negatively correlated with cefazolin AUD(P<0.05);The resistance rate to cefazolin was negatively correlated with the AUD of ceftazidime and cefotaxime(P<0.05);The resistance rate to cefotaxime was negatively correlated with piperacillin/tazobactam and cefotaxime AUD(P<0.05);The resistance rate to cefoxitin was negatively correlated with the AUD of cefotaxime(P<0.05);The resistance rate to imipenem was negatively correlated with amoxicillin/clavulanic acid AUD(P<0.05).The resistance rate of Klebsiella pneumoniae to amoxicillin/clavulanic acid was negatively correlated with the AUD of piperacillin/tazobactam(P<0.05);The resistance rate to cefoxitin was negatively correlated with the AUD of piperacillin/tazobactam(P<0.05).Conclusion The drug resistance rate of Escherichia coli and Klebsiella pneumoniae is related to a variety of antibiotics AUD.We should strengthen the rational control of antibiotics and delay the bacterial drug resistance.