抗菌药物使用与烧伤感染主要病原菌构成比变化的关系

Relationship between antibiotic related factors and changes in constituent ratios of main pathogens in burn infection

目的探讨烧伤病区抗菌药物使用与烧伤感染主要病原菌构成比变化之间的关系。方法计算1995年1月～2004年12月每年度烧伤病区平均每日每百张床位所消耗各类抗菌药物的每日约定剂量(DDD)数(DDDs/100人天),统计同期每年金黄色葡萄球菌(Staphylococcusaureus,Sa)、铜绿假单胞菌(Pseudomonasaeruginosa,Pa)在全部病原菌中的构成比,以及耐甲氧西林金黄色葡萄球菌(MRSA)在Sa中的比例,并对各种(类)抗菌药物的使用量与病原菌构成比的变化进行相关分析。结果10年来氨基糖苷类药物和1、2代头孢菌素的使用量大幅度下降,而含酶抑制剂类、3代头孢菌素和喹诺酮类药物的使用量大幅度提高;在单一品种的药物中,阿米卡星和头孢唑啉使用量呈明显的下降趋势,磷霉素、头孢他啶和左氧氟沙星的使用量近年来明显增加。在病原菌方面,Pa的构成比有一定幅度的下降,Sa构成比却持续升高,2003年达到最高点(44%),Sa中多重耐药MRSA比例无明显的升高趋势。相关分析表明,有多种(类)抗菌药物的使用量与Sa和Pa构成比之间存在相关关系,但MRSA在Sa中的比例仅与磷霉素的使用量呈负相关。结论增加阿米卡星、头孢唑啉等药物的使用量,减少含酶抑制剂类和糖肽类药物的使用量,有可能改变Sa构成比持续升高的趋势;而适当增加舒巴坦/头孢哌酮和碳青霉烯类药物的使用有可能降低病原菌中Pa的构成比。

Objective To investigate the relationship between antibiotic administration and the changes in constituent ratios of preponderant pathogens in infection of burn wounds in our burn unit. Methods The consumption of different kinds of antibiotics [expressed as the number of defined daily doses （DDD）/100 patient day], as well as the constituent ratio of Staphylococcus aureus and Pseudomonas aeruginosa, and percentage of methicillin-resistant S. aureus （MRSA） among all positive cultures of S. aureus were calculated from 1995 to 2004, and their correlation was analyzed. Results Within this period, it was found that the consumption of first and second-generation cephalosporins and aminoglycosides, including cefazolin and amikacin, was decreased remarkably, while the consumption of antibiotics combined with lactamase inhibitor, third-generation cephalosporins, quinolones, including ceftazidime, levofloxacin and fosfomycin, was increased significantly. At the .same time, the constituent ratio of P. aeruginosa declined to certain extent, while the constituent ratio of S. aureus gradually rase, but no increase was found in percentage of MRSA in S. aureus. The constituent ratios of S. aureus and P. aeruginosa were correlated to consumption of more than ten kinds of antibiotics or antimicrobial agents. Conclusions The results suggested that more cefazolin or amikacin and less antibiotics with lactamase inhibitor or third generation cephalosporins were used in the treatment of burn infection might help decrease the infection caused by S. aureus, and that when more carbopenem or cefoperazone/sulbactam were used there might be a tendency of declination of P. aeruginosa infection.