2011—2015年暨南大学医学院附属东莞医院细菌耐药性监测及抗菌药物应用分析

Analysis on Application of Antibiotics and Monitoring of Bacterial Resistance in Dongguan Hospital Affiliated to Medical College of Jinan University During 2011-2015

目的:了解暨南大学医学院附属东莞医院临床分离菌的构成、细菌耐药性的变迁及其与抗菌药物使用的相关性,为临床合理用药提供依据。方法:采用回顾性调查方法,收集病原菌培养结果、抗菌药物使用和细菌耐药率数据,采用SPSS 17软件统计分析细菌耐药率与抗菌药物用药频度之间的相关性。结果:2011—2015年共收集分离菌株7 987株,以革兰阴性菌株为主(5 429株,占68.0%);菌株数排序居前7位的分离菌分别为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、铜绿假单胞菌、肺炎链球菌、流感嗜血杆菌、鲍曼不动杆菌。大肠埃希菌和肺炎克雷伯菌对碳青霉烯类抗菌药物、阿米卡星、哌拉西林他唑巴坦和头孢哌酮舒巴坦的耐药率均<5%;出现了耐碳青霉烯类抗菌药物肠杆菌科细菌(carbapenem-resistant enterobacteriaceae,CRE);未检出耐万古霉素和利奈唑胺的葡萄球菌;铜绿假单胞菌、肺炎链球菌和流感嗜血杆菌对常用抗菌药物均有较好的敏感性,但耐碳青霉烯类抗菌药物铜绿假单胞菌株数呈上升趋势;除头孢哌酮舒巴坦外(26.4%),鲍曼不动杆菌对其他抗菌药物的耐药率均>30%。Pearson相关分析结果显示,大肠埃希菌、肺炎克雷伯菌对头孢他啶、头孢吡肟的耐药率与相应药物的用药频度呈正相关(r>0.8,P<0.05);铜绿假单胞菌的耐药率与美罗培南、亚胺培南的用药频度呈正相关(r>0.8,P<0.05),与环丙沙星的用药频度呈负相关(r<-0.8,P<0.05);鲍曼不动杆菌的耐药率与头孢他啶、美罗培南的用药频度呈正相关(r>0.8,P<0.05),与环丙沙星的用药频度呈负相关(r<-0.8,P<0.05)。结论:5年来,大肠埃希菌检出率均最高,流感嗜血杆菌的检出率逐年升高,出现了CRE,应引起重视。此外,鲍曼不动杆菌耐药现象严重,应根据药物敏感性试验结果选药。

OBJECTIVE： To investigate the constitution of clinical isolated bacteria, evolution of bacterial resistance and the correlation with the application of antibiotics, so as to provide reference for the rational drug application in clinic. METHODS： Retrospective investigation methods was adopted, results of pathogenic bacteria culture, consumption of antibacterial drugs and drug resistance rate of bacteria were collected. And SPSS 17 software was used for partial correlation analysis between drug resistance and medication frequence of antibiotics. RESULTS ： A total of 7 987 clinical isolates were collected from 2011 to 2015, of which gram positive organisms took the lead（5 429 cases, 68.0% ）, the top 7 isolates ranked by number of strains were respectively escherichia coli, klebsiella pneumoniae, staphylococcus aureus, pseudomonas aeruginosa, streptococcus pneumoniae, haemophilus influenzae and acinetobaeter baumannii. The drug resistance rate of escherichia coli and klebsiella pneumoniae to carbapenems antibiotics, amikacin, piperacillin and tazobactam and cefoperazone and sulbactam were 〈5%. Carbapenem-resistant enterobacteriaceae（CRE） strains were identifyied. No staphylococcus strains were found resistant to vancomycin and linezolid. Pseudomonas aeruginosa, streptococcus pneumoniae and hemophilus influenza were still high susceptibility to the commonly used antibiotics, yet the number of strains of resistance of carbapenem antibiotics were in an increasing tendency. Except for cefoperazone and sulbactam （26. 4% ）, the drug resistance rate of acinetobacter baumannii to other antibiotics were 〉 30%. According to pearson correlation statistics, the drug resistance rate of escherichia coli and klebsiella pneumoniae to ceftazidime pentahydrate and cefepime was positively related to DDDs of corresponding drugs （ r 〉 0. 8, P 〈 0. 05 ）. The drug resistance rate of pseudomonas aeruginosa was positively related to DDDs of meropenem and imipenem （ r 〉 0. 8, P 〈 0. 05 ）, yet it was negatively related to DDDs of ciprofloxacin （ r 〈 - 0. 8, P 〈 0. 05 ）. The drag resistance rate of acinetobacter baumanii was positively related to DDDs of ceftazidime and meropenem （r 〉 0. 8,P 〈 0.05）, yet it was negatively related to DDDs of ciprofloxacin （ r 〈 - 0. 8, P 〈 0. 05）. CONCLUSIONS ： The five-year surveillance data indicated that bacterial resistance was on the rise. escherichia coli was still the most common pathogens in clinical isolates. Attention should be paid to the increasing prevalence of hemophilus influenza and CRE. Besides, the resistance of acinetobacter baumannii isolates were so severe, the drugs should be selected according to local susceptibility testing data.