2013—2015年天津市人民医院病原菌的耐药性和抗菌药物用量的相关性分析

Correlation analysis between drug resistance of pathogenic bacteria and dosage of antibiotics in Tianjin Union Medical Center from 2013 to 2015

目的分析天津市人民医院2013—2015年抗菌药物使用情况和病原菌耐药性,分析抗菌药物用量与细菌耐药性的相关性,指导临床合理用药。方法统计天津市人民医院2013年1月—2015年12月病原菌的分布、耐药性和抗菌药物的使用情况,并采用Pearson法对病原菌的耐药性与抗菌药物用量的相关性进行分析。结果 2013—2015年分离出病原菌25 134株,以革兰阴性杆菌居多,其次为革兰阳性球菌,前5位分别为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、凝固酶阴性葡萄球菌。金葡菌属对青霉素、红霉素耐药率偏高;粪肠球菌对绝大多数所测试抗菌药物的耐药率均显著低于屎肠球菌。鲍曼不动杆菌对大多种抗菌药物的耐药率明显上升,对碳氢霉烯的耐药率增长迅速。铜绿假单胞菌的耐药情况较好。应用抗菌药物用药频度(DDDs)排名前5位集中在头霉素、哌拉西林钠他唑巴坦、头孢菌素类,其中头霉素类药物头孢西丁、头孢米诺连续3年均居前5位。特殊级抗菌药物比阿培南、亚胺培南DDDs增长迅速。鲍曼不动杆菌对哌拉西林他唑巴坦、美罗培南的耐药率与其DDDs显著相关(P<0.05);大肠埃希菌、肺炎克雷伯菌对头孢西丁的耐药率与其DDDs显著相关(P<0.05);其余病原菌耐药率与DDDs的相关性较小,无统计学意义。结论天津市人民医院2013—2015年住院抗菌药物监控指标均达标,部分病原菌耐药性呈持续下降趋势,但随着头霉素类和碳氢霉烯类抗菌药物的大量使用,细菌耐药形势依然严峻,需加强临床抗菌药物的使用管理和细菌耐药性监测。

Objective To investigate the application of antibiotics and bacterial resistance in Tianjin Union Medical Center from 2013 to 2015, and to probe into the correlation between the drug resistance of pathogenic bacteria and the dosage of antibiotics, so as to provide guidance for rational drug use in clinic. Methods The distribution, drug resistance of pathogens, and usage of antibiotics in Tianjin Union Medical Center from January 2013 to December 2015 were collected. The correlation between the drug resistance of pathogenic bacteria and the dosage of antibiotics were analyzed by Pearson method. Results There were 25 134 strains which Gram negative bacilli were the most, and followed by Gram positive bacteria. The top 5 of the target pathogens isolated were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter bauman coli, coagulase negative staphylococcus. The drug resistance rate of Staphylococcus aureus to penicillin and erythromycin was high. The resistance rate of Streptococcus faecalis aginst the vast majority of the tested antibiotics was significantly lower than that of Enterococcusfaecium. The resistant rate of P aeruginosa to the large variety of antimicrobial agents increased significantly, and the drug resistance rate of the strains increased rapidly. The drug resistance ofP aeruginosa was better. Defined daily doses （DDDs） of cephamycins, cephalosporins andpiperacillin tazobactam were high, and cefoxitin and ceftazidime ranked in the top 5 from 2013 to 2015. DDDs of special class of antibacterial drugs imipenem and biapenem increased rapidly. Drug resistance ofP. aeruginosa against piperacillin tazobactam and meropenem DDDs were significantly correlated （P 〈 0.05）, correlation of E. coli and K. pneumoniae resistant rate against cefoxitin DDDs were significant （P 〈 0.05）, but there were no statistical significances between the rest of the resistance rate of bacteria and DDDs. Conclusions The monitoring indicators of antibiotics for inpatients are up to standard in Tianjin Union Medical Center from 2013 to 2015, and the resistance of some pathogenic bacteria is in a decline tendency. With the large consumption of cephamycins and carbapenems, the current situations of bacterial resistance remains are severe which needs to strengthen the management of clinical use of antibiotics and monitor of bacterial resistance.