停用哌拉西林他唑巴坦后抗菌药物用量及细菌敏感性变化分析

Changes of Antimicrobial Usage Amount and Bacterial Sensitivity before and after Suspending Piperacillin Tazobactam

目的观察停用哌拉西林他唑巴坦对常见革兰阴性菌药物敏感性变化,以及对常用抗铜绿假单胞菌药物用量和细菌敏感性的影响,为临床抗菌药物管理提供依据。方法分析2012年至2013年住院患者分离的铜绿假单胞菌及其他常见革兰阴性菌药物敏感性变化情况,并统计常用抗铜绿假单胞菌药物用药频度变化。结果停用哌拉西林他唑巴坦后,常见革兰阴性菌对哌拉西林他唑巴坦的耐药率明显下降,包括铜绿假单胞菌,且可改善铜绿假单胞菌对部分抗菌药物(如头孢哌酮舒巴坦、美罗培南等)的敏感性。对其他常见抗铜绿假单胞菌药物的用量无明显影响。结论有计划地停用某种抗菌药物,可改善该药对目标细菌耐药率,且对其他抗菌药物用量无明显影响,可作为抗菌药物管理一种有效、可行的手段,特别是对耐药严重的抗菌药物更有临床意义。

Objective To observe the changes of the antimicrobial usage amount commonly used to anti- Pseudomonas aeruginosa and the resistance of Gram- negative bacterium before and after suspending Piperacillin Tazobactam, in order to provide the basis for clinical management of autimicrobial agents. Methods The antibacterial resistance test results of Gram- negative bacterium which were based on isolation from inpatients between 2012 and 2013, were analyzed. The usage amount of antibiotics was analyzed in terms of quarters using Defined Daily Dose （DDD） and DDDs by the hospital office systems which were commonly used to anti-Pseudomonas aeruginosa. Results The resistance rates of Piperacillin Tazobactam decreased significantly due to the suspension of some of Gram- negative bacterium, such as Pseudomonas aeruginosa and Eseherichia coli. The resistance rates of some anti- Pseudomonas aeruginosa antimicrobial drugs to Pseudomonas aeruginosa were also decreased significantly, such as Cefoperazone Sulbactam, Meropenem, and so on. At the same time, the DDDs was not effected significantly. Conclusion It may be an effective and feasible measure to suspense some antimicrobial drugs plainly for clinical management of antimicrobial agents, especially for the one which had high resistance rate. It is beneficial to decline of the resistance of targeted bacterium, and has no significant impact on the other antimicrobial usage.