大肠埃希菌耐药性变迁及抗菌药物应用分析

Change of drug resistance of escherichia coli and use of antibiotics

目的分析医院大肠埃希菌的临床分布、耐药性变化及常用抗菌药物临床应用情况,为临床合理使用抗菌药物、有效控制感染提供参考依据。方法对2013年1月—2014年12月1146株大肠埃希菌的分布及耐药率进行回顾性分析,采用用药频度（DDDs）、使用强度等指标,对同期抗菌药物使用情况进行分析。结果 1146株大肠埃希菌中725株产ESBLs,占63.3%,菌株主要分离自尿液511株和痰液250株,分别占44.6%、21.8%;药敏结果显示：大肠埃希菌对哌拉西林、氨苄西林耐药率〉80.5%,对庆大霉素、左氧氟沙星、环丙沙星、头孢噻肟等耐药率在52.7%-72.6%,对哌拉西林/他唑巴坦、阿莫西林/克拉维酸、阿米卡星耐药率较低,分别为4.9%、6.3%、6.5%,对美罗培南和亚胺培南耐药率最低,分别〈1%;用药频度结果显示头孢呋辛、头孢哌酮/舒巴坦、左氧氟沙星使用强度连续2年保持在前3位,美罗培南、亚胺培南使用强度保持较低水平。结论大肠埃希菌主要引起泌尿道和呼吸道感染,并呈现多重耐药现象,哌拉西林/他唑巴坦、阿莫西林/克拉维酸以及美罗培南、亚胺培南是治疗大肠埃希菌特别是产ESBLs菌的首选药物,应继续加强耐药性监测,合理应用抗菌药物。

Objective： This study aimed to analyze the clinical distribution and change of antimicrobial resistance of Escherichia coli and observe the use of clinical antibiotics so as to provide guidance for the rational use of antibiotics and the effective control of infection. Methods Retrospective review on distribution and antimicrobial resistance of the 1146 strains Escherichia coli collected during January 2013 to December 2014,the use of corresponding antibiotics was analyzed in terms of DDDs and use intensity. Results A total of 725 Escherichia coli strains were isolated from the 1146 strains（ 63. 3%）,mostly from urine specimens（ 511 strains,44. 6%） and sputum specimens（ 250 strains,21. 8%）. According to the resistance monitoring results,the antimicrobial resistance rate of Escherichia coli to piperacillin and ampicillin were more than 80. 5%,the antimicrobial resistance rate to gentamicin,levofloxacin,ciprofloxacin,and cefotaxime varied at52. 7% - 72. 6%. To piperacillin-tazobactam,amoxicillin-clavulanic acid and amikacin the resistant rate were lower,4. 9%,6. 3% and 6. 5%,respectively,and meropenem and imipenem resistant rate was the lowest,respectively,less than 1%. The DDDs showed that the use intensity of cefuroxime sodium,cefoperazone-sulbactam,and levofloxacin ranked in the top three for two consecutive years,while that of meropenem and imipenem stayed a relatively low level. Conclusion Escherichia coli mainly caused by urinary tract and respiratory tract infection,and showed multiple drug resistance,phenomenon,piperacillin-tazobactam,amoxicillin-clavulanate and meropenem,imipenem were the drugs of choice for Escherichia coli treatment especially for the ESBLs producing bacteria. We should continue to strengthen the monitoring of insecticide resistance,reasonable application of antibacterial drugs.