鲍曼不动杆菌耐药性与抗菌药物使用情况的相关性分析

Relationship between antibiotic use and antimicrobial resistance in Acinetobacter baumannii

目的了解鲍曼不动杆菌耐药性与抗菌药物使用情况的相关性,为临床合理用药、控制感染提供依据。方法回顾性调查上海交通大学医学院附属瑞金医院2006—2010年住院患者抗菌药物的使用情况,计算各类药物的使用强度;同时采用K-B法检测同期住院患者送检标本中分离的鲍曼不动杆菌对常用抗菌药物的耐药率;应用SPSS16.0统计软件进行数据分析。结果分离自住院患者的鲍曼不动杆菌对受试抗菌药物耐药率高,仅对阿米卡星、碳青霉烯类及β内酰胺酶抑制剂复方的耐药率相对较低。临床上氟喹诺酮类及头孢菌素类抗菌药物使用强度较高。鲍曼不动杆菌对亚胺培南、美罗培南的耐药率与碳青霉烯类抗生素的使用强度呈正相关(r均=0.975,P均<0.05)。鲍曼不动杆菌对头孢菌素类、氨基糖苷类、氟喹诺酮类和β内酰胺酶抑制剂复方的耐药率与这些药物的使用强度无相关性(P均>0.05)。结论鲍曼不动杆菌耐药现象严重,需引起重视,经验治疗时可选择阿米卡星和β内酰胺酶抑制剂复方类药物,碳青霉烯类抗生素的使用应严格掌握适应证。

Objective To investigate the relationship between antibiotic use and antimicrobial resistance in Acinetobacter bau mannii for rational use of antibiotics. Methods Antibiotic use density （AUD） of common antibiotics in hospitalized patients were collected in a tertiary hospital between 2006 and 2010. Clinical isolates of A. baumannii from those patients were collect ed. The resistance to common antimicrobial agents were tested by disk diffusion method according to Clinical and Laboratory Standards Institute （CLSI, 2012） guidelines. Relationship between antibiotic use and antimicrobial resistance in A. baumannii was analysed by SPSS 16.0. Results The resistant rates of A. baumannii isolated from inpatients were high. Consumption of cephalosporins and quinolones were large. There was a positive correlation between the resistant rate of A. baumannii to imi penem and AUD of carbapenems （r = 0. 975, P^0.05）. The resistant rate of A. baurnannii to meropenem showed significantly positive relation to AUD of carbapenems （r = 0. 975, P%0.05）. Resistant rates of aminoglycosides, quinolones, cephalospo rins and beta-lactamase inhibitors was not correlated to AUD of those antibiotics. Conclusions We should pay more attention to the high prevalence of resistant A. baumannnii strains. Application of imipenem and meropenem should be strictly controlled. Arnikacin and beta lactamase inhibitors are better choice for empirical antibiotic therapy in the treatment of infections caused by A. baumannii.