大肠埃希菌耐药性与抗菌药物使用关联性分析

Evaluation and Analysis of Drug Resistance of Escherichia Coli and Relationship of the Antibacterial Use

目的:了解本院临床标本中分离培养的大肠埃希菌(Eco)对抗菌药物耐药性变化情况,与同期抗菌药物的使用情况进行分析评价,为临床合理使用抗菌药物提供参考。方法:收集2005年8月～2006年4月本院门诊及住院患者的各类临床标本,采用Kirby-Bauer(K-B)纸片扩散法进行ESBLs的检测,同时统计同期抗菌药物使用频度排序及销售金额排序情况,对两者进行关联性分析。结果:Eco产ESBLs的检出率为58．6％。Eco对亚胺培南全部敏感,对哌拉西林他唑巴坦和头孢哌酮舒巴坦耐药率仅2％和4％,对头孢噻肟和头孢他啶的耐药率分别为59％,55％。三代头孢菌素类和喹诺酮类药物的销量一直居高不下,使用频度居于前3名。三代头孢菌素加酶抑制药的使用也有上升趋势。结论:抗菌药物的大量使用与Eco的耐药性变化有直接的关系,应加强临床抗菌药物管理,提高合理用药水平。

Objective： To investigate the variation of the drug resistance of Escherichia coli（Eco） against antibacterial in clinical specimens in the hospital, and to evaluate the simultaneous use of antibacterial, to explore to provide the reference for the reasonable clinical use of antibacterial. Method： Eco was separated from all kinds of clinical specimens of out-patients and in-patients in the hospital from August of 2005 to April of 2006, and ESBLs was detected with Kirby-Bauer （K-B） disk diffusion method. It was also counted that the antibacterial drugs ranked the first 30 in sales per month and their use frequencies in the same period in the hospital. Result： The detectable rate of producing ESBLs Eco was 58.6%. Eco was completely sensitive to imipenem. It had lower resistance rates, only 2% and 4%, against piperacillin/tazobactam and cefoperazone/sulbactam; and had 59% and 55% resistance rates respectively against cefotaxime claforan and ceftazidime pentahydrate in the third generation cephalosporin. The third generation cephalosporin and quinolones kept high in sales and their use frequencies ranked the first three. The use of the third generation cephalosporin with anhydrase inhibitors also had an uptrend. Conclusion： There is a direct relation between the use of a great deal of antibacterial and the mutative drug resistance of Eco. It is necessary to strengthen its clinical management and to raise the level of drug use.