2013-2017年云南省某医院抗菌药物使用情况及其对大肠埃希菌和肺炎克雷伯菌的耐药性分析

Analysis on antibiotic use and drug resistance of Escherichia coli and Klebsiella pneumoniae in a hospital in Yunnan,2013–2017

目的分析2013—2017年云南省某医院抗菌药物使用情况及其对大肠埃希菌和肺炎克雷伯菌的耐药影响,为临床合理使用抗菌药物、降低细菌耐药率提供指导依据。方法对常用抗菌药物的使用频度和强度及同期分离的大肠埃希菌和肺炎克雷伯菌的耐药情况进行回顾性调查分析。结果 2013—2017年该医院抗菌药物总使用强度逐年上升,2016年后有所下降。大肠埃希菌耐药率与头孢他啶和头孢呋辛使用频度呈正相关,与其他常用抗菌药物使用频度均负相关。肺炎克雷伯菌耐药率与美洛培南和左氧氟沙星使用频度呈正相关(r=0.980、0.902,P=0.003、0.036),与头孢他啶、头孢吡肟、庆大霉素和头孢哌酮/舒巴坦使用频度呈正相关,与头孢呋辛、亚胺培南和哌啦西林/他唑巴坦使用频度呈负相关。结论大肠埃希菌和肺炎克雷伯菌与临床常用抗菌药物的使用频度有一定相关关系,特别是肺炎克雷伯菌的耐药率与医院使用量较大的美洛培南、左氧氟沙星的使用频度具有相关性,应引起临床足够重视。

Objective To analyze the antibiotic use in recent years in our hospital,analyze its influence on the prevalence of drug resistance of Escherichia coli and Klebsiella pneumoniae and provide guidance for the reasonable clinical use of antibiotics and the control and decrease of bacterial drug-resistance.Methods The use frequency and use dose of antibiotics,and the drug resistance level of E.coli and K.pneumoniae isolated in our hospital from 2013 to 2017 were investigated.Results The antibiotic use dose(AUD) increased year by year from 2013 to 2015 and decreased in 2016 in our hospital.According to the analysis of defined daily dose(DDD),the drug resistant rate of E.coli was positively correlated with the use frequencies of ceftazidime and cefuroxime,but negatively correlated with the use frequencies of other antibiotics.While the drug resistance rate of K.pneumoniae was obviously positively correlated with the use frequencies of meropenem and levofloxacin(r=0.980,P=0.003 and r=0.902,P=0.036),and positively correlated with use frequencies of ceftazidime,cefepime,gentamicin and cefoperazone/sulbactam,but negatively correlated with use frequencies of cefuroxime,imipenem and piperacillin/tazobactam.Conclusion The use frequencies of commonly used antibiotics had certain relationship with the drug resistance of E.coli and K.pneumoniae,especially the relationship between the high frequency uses of meropenem and levofloxacin and the drug resistance of K.pneumoniae,to which close attention should be paid.