抗菌药物使用与医院感染铜绿假单胞菌敏感性的关系

Relationship Between Antimicrobial Use and Antimicrobial Susceptibility in Pseudomonas aeruginosa Causing Nosocomial Infections

目的评价抗菌药物的使用与抗菌药物对医院感染铜绿假单胞菌(PAE)敏感性之间的关系。方法监测2003年1月-2007年12月头孢他啶(CAZ)、头孢吡肟(FEP)、左氧氟沙星(LVX)、哌拉西林/他唑巴坦(TZP)、头孢哌酮/舒巴坦(CFS)、亚胺培南(IMP)、美罗培南(MER)每年的消耗量(用DDD/1000人日表示)和主要抗菌药物对铜绿假单胞菌的敏感率。结果出院占用总床日数(人日)2003年为60069、2007年为74 442,呈增加趋势(P<0.05);消耗量减少CAZ约20倍、CFS约6倍、LVX约2倍,增加FEP约30倍、TZP约100倍(P<0.05);医院感染的PAE对CAZ、CFS敏感率呈上升的趋势(P<0.05),2003-2007年上升了10%;PAE对FEP的敏感率呈下降趋势,2003-2007年下降了20%;CAZ、FEP、CFS的消耗量与敏感率显著负相关(r<-0.72,P<0.05)。结论结论2003-2007年CAZ、CFS敏感率的上升与其消耗量减少、FEP敏感率的下降与其消耗量增加显著相关。

OBJECTIVE To evaluate the relationship between and antimicrobial usage antimicrobial susceptibility of Pseudomonas aeruginosa （PAE） causing nosocomial infections. METHODS Monitored the data on the yearly patient-days and the yearly consumption[defined daily dose （DDD） per 1000 patient days] the consumption of ceftazidime, cefepime, levofloxacin, piperacillin/tazobactam, cefoperazone/sulbactam, mipenem and meropenem from Jan 2003 to Dec 2007. was analyzed. Disk susceptibility data of P. aeruginosa（PAE） causing nosocomial infections were tested. RESULTS The yearly patient-days of our department significantly increased from 60 069 in 2003 to 74 442 in 2007 （P〈0.05）. The usage of ceftazidime, cefoperazone/sulbactam and levofloxacin reduced 20 times, 6 times and 2 times in 5 years, respectively（P〈0.05）. The consumption of piperacillin/tazobactam and cefepime increased 100 times and 30 times in 5 years, respectively（P〈0. 05）. Increasing trends of ceftazidimesusceptible and cefoperazone/sulbactam-susceptible PAE（P〈0.05）and decreasing trends of cefepime-susceptible PAE were noted from Jan 2003 to Dec 2007. The increments of susceptibility to CAZ and CFS were about 10%, and the decrement of susceptibility to FEP was 20% The rise in ceftazidime-susceptible and cefoperazone/ sulbactam-susceptible PAE was significantly correlated with decreased consumption of ceftazidime and cefoperazone/sulbactam,and the fall in cefepime-susceptible PAE was significantly correlated with increased consumption of cefepime（ r〈-0. 72, P〈0. 05）. CONCLUSIONS The consumption of CAZ, FEP, and CFS is significantly negatively correlated with their susceptibility of PAE causing nosocomial infections.