上海交通大学医学院附属瑞金医院大肠杆菌耐药率与抗菌药物使用强度8年的相关性分析

Analysis of the relationship between drug resistance rate and intensity of antibacterials against Escherichia coli during the last 8 years in Ruijin Hospital affiliated to School of Medicine,Shanghai Jiaotong University

目的:通过对上海交通大学医学院附属瑞金医院2004-2011年住院患者抗菌药物的使用强度与大肠杆菌对各类抗菌药物的耐药率进行相关性分析,为临床合理用药提供依据。方法:采用回顾性调查方法,对本院2004-2011年住院患者常用抗菌药物的使用强度及大肠杆菌对各类抗菌药物的耐药率进行统计和排序,应用SPSS10.0统计软件包进行数据分析,用Spearman相关法进行相关性分析。结果:大肠杆菌对环丙沙星的耐药率与氟喹诺酮类药物的使用强度呈显著正相关(r=0.814 4,P<0.05);大肠杆菌对头孢呋辛的耐药率与第二代头孢菌素的使用强度呈显著正相关(r=0.904 8,P<0.05),对头孢他啶的耐药率与头孢类药物的用量呈显著正相关(r=0.857 1,P<0.05);大肠杆菌对碳青霉烯类药物、氨基糖苷类药物及β-内酰胺酶抑制剂的耐药率与这些药物的使用强度无关。结论:氟喹诺酮类与第三代头孢菌素不适用于对大肠杆菌感染的经验治疗;对碳青霉烯类药物的使用应严格掌握适应证,碳青霉烯类药物仅适用于大肠杆菌所致的严重感染;β-内酰胺酶抑制剂和氨基糖苷类药物是治疗大肠杆菌感染可供的选择。

Objective： To investigate the relationship between drug resistance rate and intensity of antibacterials against Escherichia coli in the treatment of inpatients from 2004 to 2011 in Ruijin Hospital affiliated to School of Medicine, Shanghai Jiaotong University, so as to provide evidence for rational use of antibacterials. Methods： The intensity of commonly used antibaeterials and resistance rates of E. coli to various antibacterials were statistically calculated and analyzed with retrospective analysis. Spearman correlation analysis was used to analyze the relationship between drug resistance rates of E. coli and the intensity of antibaeterials, and data analyses were carried out by using SPSS 10. 0 software kit. Results： Ciprofloxacin resistance rate of E. coli was positively correlated to the intensity of fluoroquinolones （r=0. 814 4, P〈0.05）. Cefuroxime resistance rate of E. coli was positively correlated to the intensity of the second generation cephalosporins （r= 0. 904 8, P〈0.05）. Ceftazidime resistance rate of E. coli was positively correlated to the amount of cephalosporins （r= 0. 857 1, P〈0.05）. The drug resistance of E. coli to carbapenems, aminoglycosides and β-lactamase inhibitors were not correlated to intensity of antibacterials. Conclusion： Fluoroquinolones and the third generation cephalosporins were not suitable for empirical treatment of E. coli infection. Carbapenems should be applied strictly in accordance with indications and they could be used only in case of serious infection caused by E. cogi. β-lactamase inhibitors and aminoglycosides might be better choice for the treatment of infection caused by E. coli.