第三代头孢菌素的用药频度与细菌耐药性相关分析

Analysis on the DDDs of the third generation cephalosporin and drug-resistant state

目的分析第三代头孢菌素(简称TGC)的用药频度(DDDs)、临床分离的革兰阴性杆菌(G^-杆菌)对TGC的耐药率、G^-杆菌产超广谱β-内酰胺酶(ESBL_s)率以及三者之间的相关性,为合理使用该类抗菌素提供参考。方法以中等城市五家医院三年用药资料和药敏试验结果为研究对象,采用世界卫生组织(WHO)推荐的限定日剂量(Defined daily Dose,DDD)法分析TGC的DDD_s;采用纸片扩散法、Microscan系统的Mic法进行药敏试验;用直线相关分析法考察三者之间的相关性。结果三年TGC总的DDD_s为130.64万个治疗日,2000、2001、2002年的DDDs分别为33.35、43.12、54.17万个治疗日;三年共分离出G-杆菌3603株,2000、2001、2002年分离菌株数分别为:1191株、1148株、1264株。三年来G-杆菌对TGC的年均耐药率为40.92%,2000、2001、2002年的耐药率分别为39.04%、41.05%、42.58%;三年G^-杆菌年均产ESBL_s率为33.67%,2000、2001、2002年分别为29.64%、32.58%、38.45%;DDD_s与G-杆菌耐药率相关系数r=0.99,DDD_s与G-杆菌产ESB_s率相关系数r=0.98,。G^-杆菌耐药率与产ESBL_s率相关系数r=0.97。结论 DDDs增长过高过快,G-杆菌对TGC的耐药率偏高,G-杆菌产ESBL_s率偏高,DDD_s与G^-杆菌耐药率呈正相关,DDD_s与G^-杆菌产ESB_s率呈正相关;G-杆菌耐药率与产ESBL_s率呈正相关。降低药物的DDDs能降低细菌对药物的耐药率和减少细菌耐药菌株的变异,建议临床采取有效措施,科学合理使用TGC,整体降低TGC的DDD_s,进而降低或延缓细菌耐药的蔓延和扩散,保证用药的有效和安全。

OBJECTIVE To analyze the DDDs of the third generation cephalosporin(TGC),the drug-resistance of clinical isolated G^- bacillus to TGC and the ESBLs producing status.To provide reference for administrating this kind of antibiotic in a scientific and rational mode.METHODS Select representative five hospitals in our city.Within three years(2000-2002),the consumptions of TGC and the results of clinical drug-sensitivity experiments served as sample dates to analyze.Defined daily Doses(DDDs) of each antibiotic was analyzed with DDD method recommended by WHO,i.e.therapeutic days.We accomplished drug-sensitivity experiment with paper diffusion method and Microscan systemic Mic method,moreover experimental procedures and explanation according strictly to the rule made by NCCLS in 1999.to study the correlation of them.RESULTS In three years,the total DDDs were 13,064,000 therapeutic days,i.e.3,335,000 in 2000;4,312,000 in 2001;5,417,000 in 2002.3603 drug-resistant G^- bacillus were isolated,i.e.1191,1148,1264 in 2000,2001,2002.The average drug-resistant ratio of G^- bacillus to TGC was 40.92%,i.e.39.04%,41.05%,42.58%.in 2000,2001,2002.The average ESBLs producing ratio was 33.67%,i.e.29.64%,32.58%,38.45%in2000,2001,2002.The relative index was 0.99 between DDDs and drug-resistant ratio of G^- bacillus,0.98 between DDDs and ESBLs producing ratio,and 0.97 between drug-resistant ratio of G^- bacillus and ESBLs producing ratio.CONCLUSION The DDDs of TGC,drug-resistant ratio of G^- bacillus to TGC and the ESBLs producing ratio were high,and they appeared to be positively correlative.To decrease the DDDs of TGC could decrease drug-resistance and reduce ESBLs bacteria.The results indicated that we must be attached importance to the connection between DDDs and drug-resistance of bacteria and its harms,take effective measures and administrating TGC scientifically and rationally.