某院1998—2010年两种非发酵菌耐药率情况及与抗生素使用相关性分析

Antimicrobial resistance of two non-fermenting bacteria and correlation with antibiotic consumption between 1998 and 2010 in a hospital

目的研究1998—2010年铜绿假单胞菌、鲍曼不动杆菌两种非发酵菌耐药性水平变化情况,以及耐药率与抗生素使用之间的相关关系。方法回顾性调查1998—2010年本院铜绿假单胞菌、鲍曼不动杆菌两种非发酵菌分离及耐药情况,同时调查同期抗生素的使用消耗情况,采用世界卫生组织(WHO)推荐的限定日剂量(DDD)法分析抗生素的用药频度(DDDs),用SPSS13.0统计软件统计抗生素使用与细菌耐药之间的相关分析。结果铜绿假单胞菌对丁胺卡那、头孢他啶较敏感,耐药率在20%左右,对其他抗生素的耐药率都超过了30%。鲍曼不动杆菌对亚胺培南、美洛培南耐药率上升较快,到2010年接近40%,耐药率较低的为头孢哌酮舒巴坦,但也超过了30%。统计结果显示亚胺培南、氨曲南的使用DDDs与铜绿假单胞菌的耐药率呈正相关;亚胺培南、美洛培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦的使用DDDs与鲍曼不动杆菌的耐药率呈正相关。铜绿假单胞菌与不同类抗生素累计DDDs之间相关性统计显示头孢类抗生素的使用与头孢哌酮、氨曲南及亚胺培南的耐药率之间,复方制剂的使用与环丙沙星、左氧氟沙星的耐药率之间,碳青霉素类抗生素的使用与头孢哌酮、氨曲南及亚胺培南的耐药率之间呈正相关关系。鲍曼不动杆菌耐药率与不同类抗生素累计DDDs之间相关性统计显示,头孢类抗生素的使用与亚胺培南、头孢噻肟及哌拉西林钠他唑巴坦的耐药率之间,复方制剂的使用对头孢他啶、环丙沙星及头孢哌酮/舒巴坦耐药率之间,碳青霉烯类抗生素的使用对亚胺培南、美洛培南、头孢噻肟及哌拉西林/他唑巴坦耐药率之间呈正相关。结论抗菌药物的使用对两种非发酵菌造成了很大压力,耐药现象严重。

Objective To investigate the changes in resistance levels of two non-fermenting bacteria, Pseudomonas aeruginosa and Acinetobacter baumannii, and the correlation between antibiotics consumption and antimicrobial resistance rates between 1998 and 2010. Methods A retrospective analysis was performed based on the isolation and resistance rates of two non-fermenting bacteria, Pseudomonas aeruginosa and Acinetobaeter baumannii, between 1998 and 2010. Also surveyed was antibiotics consumption of the same period. The frequency of antibiotic consumption was assessed using defined daily dose （DDD） recommended by World Health Organization. The correlation between bacterial resistance and antibiotics consumption was analyzed using SPSS13.0 software package for statistics. Results Pseudomonas aeruginosa exhibited higher sensitivity to amikacin and eeftazidime （resistance rate： approximately 20%） as compared with other antibiotics （resistance rate： over 30%）. The resistance rate of Acinetobacter baumannii to imipenem and meropenem climbed to nearly 40% by 2010, and the figure to cefoperazone sulbactam surpassed 30% despite the low ranking. The DDD of imipenem and aztreonam was shown to be positively correlated with Pseudomonas aeruginosa resistance （P〈0.05）. A positive correlation was found between DDDs of imipenem, meropenem, cefoperazone sulbactam, piperacillin tazobactam and Acinetobacter baumannii resistance （P〈0.05）. There was a positive correlation between cephalosporins consumption and resistance rates of cefoperazone, aztreonam and imipenem, between compound preparation consumption and resistance rates of ciprofloxacin and levofloxacin, as well as between carbapenems consumption and resistance rates of cefoperazone, aztreonam and imipenem （all P〈0.05）, as revealed by the correlation statistics of Pseudomonas aeruginosa-related antibiotic resistance and accumulated DDDs of various antibiotics. Based on the correlation statistics of Aeinetobacter baumannii antibiotic resistance and accumulated DDDs of various antibiotics, positive correlation was found between cephalosporins consumption and resistance rates of imipenem, cefotaxime and piperacillin tazobactam, between compound preparation consumption and resistance rates of ceftazidime, ciprofloxacin and cefoperazone sulbactam, as well as between carbapenems consumption and resistance rates of imipenem, meropenem, cefotaxime and piperacillin tazobactam （all P〈0.05）. Conclusion The challenge to two sorts of non-fermenting bacteria leads to extensive antibiotic resistance as a result of antibiotics consumption.