ICU病区临床用药与金黄色葡萄球菌分离率之间宏观量化关系的研究

Research on quantitive relationship between the pressure of drug administration and the clinical isolation rate of Staphylococcus aureus in ICU

目的:分析我院ICU病区2007-2009年临床用药与金黄色葡萄球菌(金葡菌)临床分离率之间的宏观量化关系,为临床调整用药提供依据。方法:收集并统计我院ICU病区2007年1月-2009年12月每季度用药消耗情况,将其换算成国际上相关研究所共同采用的药物使用强度指标——每100住院人天所消耗的限定日剂量(DDD/100人天),并监测金葡菌临床分离率,分别按照二者间无滞后,病原菌检出滞后1、2个季度对两者进行相关分析。结果:假设不考虑病原菌检出时间滞后因素,用药与分离率之间无显著性相关;当考虑滞后1个季度时,有3类药物的使用强度与金葡菌分离率之间存在显著性相关(P<0.05),分别为三代头孢/酶抑制剂类(负相关)、糖肽类(正相关)和二代头孢(正相关);当考虑滞后2个季度时,三代头孢/酶抑制剂类使用强度变化与金葡菌分离率变化之间存在显著负相关。结论:在考虑滞后效应的情况下,可发现用药强度与病原菌分离率之间存在宏观量化关系,为准确把握用药方向提供了参考。

Objective：To investigate the quantitive relationship between the pressure of drug administration and the clinical isolation rate of Staphylococcus aureus in intensive care unit （ICU）. Methods：The data of consumption of different kinds of antibiotics were collected from January 2007 to December 2009 quartely, and transformed to the antibiotic pressure index [expressed as the number of defined daily doses （DDD） per 100 patients per day] ,and at the same time clinical isolation rate of pathogenic Staphylococcus aureus was calculated . The correlation coefficient between pressure of medicative administration and the isolation rate of Staphylococcus aureus was calculated considering three possibilities, 0, 1,2 quarter-delayed of Staphylococcus isolation. Results： Ignoring the delayed effect of drug, no statistically significant correlation was found. Considering of one season-delayed effect, three kinds of drug were found to be correlated with the isolation rate of Staphylococcus aureus, and when two quarterdelayed effect was considered, statistically significant correlation was found in the third generation cephalosporin with enzyme inhibitor. Conclusion：The results suggest that a quantitative relationship between the pressure of administration of drugs and the clinical isolation rate of bacteria can be used with bacterial susceptibility test to more accurate direct the choice of different antibiotics.