某院近10年革兰阳性菌耐药率与抗菌药物使用相关性分析

Relationship between the DDDs of antibiotics and the resistance rates of gram-positive bacteria in a hospital

目的:了解革兰阳性菌耐药率与抗菌药物使用频数的相关性,为抗菌药物临床合理使用提供参考依据。方法:收集某医院近10年抗菌药物使用量、临床感染病原菌检出情况、革兰阳性菌耐药率,计算革兰阳性球菌耐药率变化与不同种类抗菌药物使用量变化的相关系数,进行相关性分析。结果:某院使用量最大的抗菌药物类别分别为喹诺酮类、头孢菌素类、β-内酰胺+β-内酰胺酶抑制剂类。受政策法规影响,近年抗菌药物使用量逐年下降;金黄色葡萄球菌和凝固酶阴性葡萄球菌居医院感染阳性菌的前2位,多重耐药菌株检出率仍较高,其对各类抗菌药物的耐药率多数高于50%,但检出率及耐药率均有下降趋势。两种革兰阳性菌耐药率与β-内酰胺+β-内酰胺酶抑制剂类及1代头孢使用量呈负相关,凝固酶阴性葡萄球菌耐药率与3代头孢使用量呈负相关;其对青霉素类、喹诺酮类、大环内酯类和氨基糖苷类的用量绝大多数呈正相关。结论:抗菌药物的使用量可能会影响革兰阳性球菌的耐药性,但仍需持续观察及扩大地区样本,进一步验证其相关性。

Objective： To investigate the correlation between gram positive bacteria resistance and antibac- terial drug use frequency, and provide suggestions for rational use of antibacterial agents. Methods： The data of antibiotics＇ use, pathogenic bacteria and the resistance rates of gram-positive bacteria were collected from a hospital during recent 10 years. Then the coefficients of correlation between the DDDs of the antibiotics and the resistance rates of gram-positive bacteria were calculated. Results： Quinolones （QUI）, cephalosporins （CEP） and β-lacta- mase inhibitors （βEI） were the commonest and most wildly used antibacterial drugs in the hospital. Affected by the laws and regulations, the tendency of bacteria using declined year by year. The top two infectious species of bacte- ria in the hospital were staphylococcus aureus （SAU） and coagulase negative staphylococcus （CNS）. Multi-drug resistant strain rates were usually above 50% , but the detection rates and the resistance rates showed a decrease trend. The correlation between the resistance rates and the DDDs of βEI and first generation CEP were negative. The correlation between the resistance rate of CNS and the DDDs of first generation CEP was negative too. The cor- relations between the resistance rates and the DDDs of penicillins, QUI, macrolides and aminoglycosides were posi- tive. Conclusion： The resistance rates of gram-positive bacteria can be affected by the use of antibiotic drugs. Large sample analysis should be done to verify the relevance of such correlation.