β-内酰胺酶抑制剂复合抗菌药物的使用量与产ESBLs细菌分离率关系研究

Relationship Between Isolation of ESBLs-producing Bacteria and Use of the Combinations of Beta-lactams and Beta-lactamase Inhibitors in Clinic

目的 探讨临床上产超广谱 β 内酰胺酶 (ESBLs)细菌分离率的增加 ,是否与含 β 内酰胺酶抑制剂的复合β 内 酰胺类抗菌药物使用量有关 ,为抗菌药物的规范合理使用提供依据。方法 用SPSS10 0统计软件包 ,统计分析 1998～ 2 0 0 2年 ,每年含β 内酰胺酶抑制剂的复合 β 内酰胺类抗菌药物使用量与产ESBLs的大肠埃希菌和肺炎克雷伯菌分离率间的相关性关系。结果 5年来含 β 内酰胺酶抑制剂的复合 β 内酰胺类抗菌药物使用总量从16 5 4kg/年增加到 15 6 86 8kg/年 ,增加了 84 8 4 % ;培养总样本数从 10 897份增加到 185 6 7份 ,增加了 70 4 % ;两者间相关系数r =0 884 ,P <0 0 5 ;抗菌药物使用总量与细菌分离株数间的相关系数r =0 4 4 9,P >0 0 5 ,与产ESBLs细菌总分离率间的相关系数r =0 933,P <0 0 5 ;年平均每份送检样本中此类抗菌药物的使用量与细菌分离株数间的相关系数r =0 389,P >0 0 5 ,与产ESBLs细菌总分离率间的相关系数r =0 889,P <0 0 5。结论 产ESBLs细菌分离率的增加与含 β 内酰胺酶抑制剂的复合 β 内酰胺类抗菌药物使用总量及年平均每份送检样本中此类抗菌药物的使用量呈正相关 ,提示临床使用抗菌药物应更具合理性。

OBJECTIVE To explore the increase in ESBLs-producing bacteria isolation and it′s relation with the use of the combinations of beta-lactams and beta-lactamase inhibitors to give help to antibiotics utilization. METHODS The relationship between the use of combinations of beta-lactams and beta-lactamase inhibitors and the isolation of ESBLs-producing Escherichia coli and Klebsiella pneumoniae from 1998 to 2002 was analysed. RESULTS During the five years, the total use of combinations of beta-lactams and beta-lactamase inhibitors increased from 16.54kg/year to 156.868kg/year, increased 848.4%. The samples of culture also grew up from 10 897 to 18 567, increased 70.4%. The correlation coefficient(r) was 0.884 (P<0.05). The correlation coefficient between the total use of these antibiotics and isolates or ESBLs-producing bacteria was r=0.449(P>0.05), r=0.933 (P<0.05), respectively. But,the correlation coefficient between the use of these antibiotics over every sample and the total isolations of bacteria was r=0.389(P>0.05),r=0.899(P<0.05), respectively. CONCLUSIONS The correlation is significant between the increasing in isolation of ESBLs-producing bacteria in clinic and the total use of combinations of beta-lactams and beta-lactamase inhibitors. It suggested that antibiotics be used rationally.