综合性医院碳青霉烯类用药频度与耐碳青霉烯类鲍氏不动杆菌研究

Carbepenem use frequency and carbapenem-resistant Acinetobacter baumannii in general hospitals

目的了解医院碳青霉烯类抗菌药物使用和耐亚胺培南或美罗培南鲍氏不动杆菌(IRAB或MRAB)的耐药趋势及其之间的相关性,为评价和干预临床不合理用药提供依据。方法收集2008年1月-2010年12月江苏省7所三级甲等综合性医院住院患者临床分离鲍氏不动杆菌共14 528株,分别来自患者的痰液、尿液、血液、脓液、腹水等标本,通过SPSS13.0软件,对抗菌药物使用频度(DDDs/1000)、耐药率及耐药趋势进行线性回归、相关系数法、χ2检验分析。结果 2008-2010年每半年南京4所医院检出鲍氏不动杆菌显示增加趋势(P<0.01),徐州3所医院检出鲍氏不动杆菌无变化;2008-2010年南京和徐州地区每半年IRAB和MRAB耐药率均呈显著增加趋势(P<0.05);2008-2010年每半年亚胺培南的DDDs在南京地区呈增长趋势(P<0.05),从5.97上升至8.40;每半年美罗培南的DDDs在南京和徐州地区呈增长趋势,从6.45和1.08上升至12.89和4.15,差异有统计学意义(P<0.01);亚胺培南、美罗培南和总碳青霉烯类DDDs增加趋势与ABA临床分离株数、IRAB和MRAB耐药率增加均显著相关(P<0.05)。结论避免或限制碳青霉烯类抗菌药物使用,有助于减少IRAB和MRAB耐药率及临床分离株。

OBJECTIVE To investigate the use of carbapenems antibiotics and the drug resistance rates of imipenemor meropenem-resistant Acinetobacter baumannii and observe the correlation so as to provide guidance for reasonable clinical use of antibiotics.METHODS A total of 14 528 clinical A.baumannii isolates were isolated from the patients who were hospitalized in 7three-A general hospitals of Jiangsu province from Jan 2008 to Dec 2010,and the specimens sources included the sputum,urine,blood,pus,and ascites.The linear regression,correlative coefficient and chi-square test was performed for analysis of the were antibiotic use frequency（DDDs/1000）and drug resistance rates as well as trend with the use of SPSS13.0software.RESULTS The isolation rate of the clinical A.baumannii isolates showed an upward trend in 4hospitals of Nanjing semiannually from 2008 to 2010（P〈0.01）;while the isolation rate of the clinical A.baumannii isolates did not change in 3hospitals of Xuzhou.The drug resistance rates of the imipenem-resistant A.baumannii and meropenem-resistant A.baumannii were significantly increased in Nanjing and Xuzhou semiannually from 2008 to 2010（P〈0.05）.The DDDs of imipenem showed an increasing trend in Nanjing semiannually from 2008 to 2010（P〈0.05）,increasing from 5.97 to 8.40;the DDDs of meropenem showed an increasing trend semiannually in Nanjing（increasing from 6.45 to 12.89）and Xuzhou（increasing from 1.08 to 4.15）,and there was significant difference（P〈0.01）.The use frequency increase of imipenem,meropenem and total carbepenem were correlated with increase of IRAB,MRAB and the clinical A.baumannii isolates（P〈0.05）.CONCLUSIONThe reasonable use of carbapenems antibiotics may contribute to the reduction of drug resistance rates of the imipenem-resistant A.baumannii and meropenem-resistant A.baumannii as well as the clinical isolates.