ICU常见革兰阴性菌的耐药性与抗菌药物使用强度相关性研究

Correlation between drug resistance of common gram-negative bacteria in ICUs and antibiotics use density

目的研究ICU常见革兰阴性菌的耐药性与常用抗菌药物使用强度的关系,为ICU抗菌治疗的药物选择提供参考,促进抗菌药物的合理应用。方法分析2010年7月-2014年6月ICU检出前5位革兰阴性菌的耐药率和前5位抗菌药物的使用强度变化,并对这两部分数据进行相关性分析。结果 5年ICU铜绿假单胞菌和鲍氏不动杆菌对亚胺培南的耐药率分别为50.2%、52.5%、45.9%、53.1%、58.9%和74.2%、76.3%、71.1%、84.1%、90.0%,两者对亚胺培南的耐药性与使用强度正相关(r=0.900、P<0.05和r=0.900、P<0.05);大肠埃希菌和洋葱伯克霍尔德菌对左氧氟沙星的耐药率分别为83.3%、80.3%、58.2%、70.6%、82.1%和79.3%、70.3%、39.4%、69.9%、80.6%,两者对左氧氟沙星的耐药率与使用强度正相关(r=1.000、P<0.05和r=0.900、P<0.05)。结论亚胺培南和左氧氟沙星的使用与常见革兰阴性菌对其耐药性有关,ICU需要对抗菌药物加强管理,减少细菌耐药的产生。

OBJECTIVE To study the relationship between the drug resistance of common gram‐negative bacteria in ICUs and the use density of commonly used antibiotics so as to choose appropriate drugs for antimicrobial treatment in the ICUs and facilitate the reasonable use of antibiotics .METHODS The changes of the drug resistance rates of the top 5 gram‐negative bacteria that were isolated from Jul 2010 to Jun 2014 and the use density of top 5 antibiotics were observed ,and the correlation between the two sets of data was analyzed .RESULTS In the five years ,the drug resistance rates of the Pseudomonas aeruginosa to imipenem were 50 .2% ,52 .5% ,45 .9% , 53 .1% ,and 58 .9% ,respectively ;the drug resistance rates of the Acinetibacter baumannii to imipenem were 74 .2% ,76 .3% ,71 .1% ,and 84 .1% ,and 90 .0% ,respectively ;the drug resistance to imipenem was positively correlated with the use density （r=0 .900 ,P〈0 .05 and r=0 .900 ,P〈0 .05） .The drug resistance rates of the Escherichia coli to levofloxacin were 83 .3% ,80 .3% ,58 .2% ,70 .6% ,and 82 .1% ,respectively ;the drug resistance rates of the Burkholderia cepacia to levofloxacin were 79 .3% ,70 .3% ,39 .4% ,69 .9% ,and 80 .6% , respectively ;the drug resistance rates to levofloxacin were positively correlated with the use density （r=1 .000 ,P〈0 .05 and r= 0 .900 , P〈 0 .05） .CONCLUSIONS The use of imipenem and levofloxacin is associated with the drug resistance of the common gram‐negative bacteria , and it is necessary for the ICU to strengthen the management of antibiotics so as to prevent the emergence of bacterial resistance .