大肠埃希菌和肺炎克雷伯菌耐药率及抗菌药使用分析

A Correlation Analysis Study on Antimicrobials Resistance of Escherichia coli and Klebsiella pneumoniae in our Hospital

目的:了解我院大肠埃希菌及肺炎克雷伯菌耐药性与多种抗菌药物使用量之间的相关性,为有效控制感染和临床合理用药提供依据。方法:统计我院2014~2016年大肠埃希菌及肺炎克雷伯菌的耐药性和我院2014~2016年抗菌药的用药频度(DDDs),对抗菌药的用药频度和两种细菌的耐药性分别进行相关性分析。结果:3年间,细菌对各种抗菌药物的耐药性发生一定变化。大肠埃希菌对头孢菌素类、喹诺酮类等耐药率均呈上升趋势,但对部分氨基糖苷类抗生素耐药性有缓慢下降趋势,对亚胺培南、哌拉西林/他唑巴坦耐药率较低。肺炎克雷伯菌对碳青霉烯类、喹诺酮类耐药率呈上升趋势,对哌拉西林/他唑巴坦、头孢曲松等耐药率呈下降趋势,对头孢他定、头孢吡肟、氨曲南等耐药率波动幅度较小。观察期间产超广谱β-内酰胺酶(ESBLs)大肠埃希菌及肺炎克雷伯菌的检出率总体呈下降趋势。耐药率与DDDs相关性分析显示:大肠埃希菌对头孢他啶耐药率与美罗培南DDDs呈明显正相关(P<0.05);对头孢吡肟的耐药率与头孢硫脒DDDs呈明显负相关(P<0.05);肺炎克雷伯菌对头孢曲松的耐药率与阿莫西林/克拉维酸钾DDDs呈明显正相关(P<0.05);对哌拉西林/他唑巴坦耐药率与头孢唑肟DDDs呈明显负相关(P<0.05)。结论:大肠埃希菌及肺炎克雷伯菌与抗菌药物使用量之间不同程度上存在相关性,应合理选择抗菌药物,控制和延缓耐药菌的增长。

Objective：To investigate the relationship between antibiotic use and antimicrobial resistance in Escherichia coli （E. coli） and Klebsiella pneumoniae （Kp） for rational use of antibiotics. Methods：The DDDs of antibiotics in the inpatients and the drug resistance rate of E. coli and Kp were analyzed in our hospital from 2014 to 2016. Relationship between antibiotic use and antimicrobial resistance in E. coli and Kp was analysed by SPSS 20.0. Results：During the 3-year period, E. coli strains showed increasing resistance rate to eephalosporins, quinolones, but decreasing resistance rate to aminoglyeosides. The percentage of E. coli strains resistant was low to imipenem and piperacillin-tazobactam sodium. Kp strains showed increasing resistance rate to earbapenems and quinolones, but decreasing resistance rate to piperacillin-tazobaetam sodium and eeftriaxone. The percentage of Kp strains resistant was steady to eeflazidime, eefepime and aztreonam. The prevalence of ESBLs-producing strains was generally decreasing from 2014 through 2016. Resistant rates of E. coli to ceftazidime was significant positive correlated to the DDDs of meropenem （P 〈 0.05）. Significant negative correlation was found between the resistant rate of E. coli to cefepime and the DDDs of ceftazine （P 〈 0.05）. Resistant rates of Kp to eefatriaxone was significant positive correlated to the DDDs of amoxicillin potassium elavulanate potassium （P 〈 0.05）. Significant negative correlation was found between the resistant rate of Kp to piperaeillin tazobactam and the DDDs of ceftizoxime （P 〈 0.05）. Conclusion：The correlation was found between antimicrobials consumption and resistant rate of E. coli and Kp. It is necessary to strengthen the management of the rational use of antimicrobials to control and defer the increase of antimicrobials resistance.