β-内酰胺酶抑制剂复合制剂用药频率对致病菌耐药变迁的相关性因素分析

Correlation Factors Analysis Between Medication Frequency of Betalactamase Inhibitors Compound and Change of Bacterial Drug Resistance

目的:分析医院5大质控细菌耐药变化趋势及β-内酰胺酶抑制剂复合制剂的使用量,探讨两者间的量-效关系。方法:抽取2013年1月—2017年12月间医院8种β-内酰胺酶抑制剂复合制剂(阿莫西林钠-舒巴坦钠、阿莫西林钠-克拉维酸钾、替卡西林钠-克拉维酸钾、美洛西林钠-舒巴坦钠、哌拉西林钠-舒巴坦钠、哌拉西林钠-他唑巴坦钠、头孢曲松钠-他唑巴坦钠和头孢哌酮钠-舒巴坦钠)的使用量和临床分离的5大质控菌(金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌)的耐药率资料,通过8种药物的使用量计算出用药频度(DDDs/(100人·床日)),运用统计学方法分析二者的量-效关系。结果:5大质控菌对β-内酰胺酶抑制剂复合制剂的耐药性各有不同,头孢哌酮钠-舒巴坦钠、替卡西林钠-克拉维酸钾的使用量与大肠埃希菌对替卡西林-克拉维酸钾、哌拉西林钠-他唑巴坦钠的耐药率呈正相关(P<0.05);替卡西林钠-克拉维酸钾、哌拉西林钠-舒巴坦钠的使用量与鲍曼不动杆菌对美洛西林钠舒巴坦钠的耐药率呈负相关(P<0.05);头孢哌酮钠-舒巴坦钠的使用量与肺炎克雷伯菌对哌拉西林钠-舒巴坦钠、美洛西林钠-舒巴坦的耐药率呈正相关(P<0.05),替卡西林钠-克拉维酸钾和美洛西林钠-舒巴坦钠则对它们呈负相关(P<0.05);阿莫西林钠-舒巴坦钠、哌拉西林钠-舒巴坦钠的使用量分别对肺炎克雷伯菌对阿莫西林钠-舒巴坦钠、替卡西林钠-克拉维酸钾与哌拉西林钠-他唑巴坦呈负相关(P<0.05)。结论:合理控制β-内酰胺酶抑制剂复合制剂的使用可在一定程度上减缓细菌耐药的产生。

Objective： To analyze the changing trend of bacterial drug resistance of 5 kinds of mass control bacte- ria and the dosage of β-lactamase inhibitors compound, and to explore the relationship between the dose and efficacy.. Methods： Extracting the using quantity dosage of 8 β-lactamase inhibitor compounds （such as amoxicillin sodium and sulbactam sodium, amoxicillin and clavulanate potassium, ticarcillin sodium clavulanate potassium, mezlocillin sodium and sulbactam sodium, piperacillin sodium and sulbactam sodium, piperacillin sodium and tazobactam sodium, ceftriax- one sodium and tazobactam sodium, cefoperazone sodium and sulbactam sodium） and the data of bacterial drug resis- tance rate of 5 kinds of clinical isolation quality control bacteria （such as Staphylococcus aureus, Escherichia coli, Kleb- siella pneumoniae, Acinetobacter baumannii, Pseudornonas aeruginosa） from January 2013 to December 2017 in our hospital, so as to get the DDDs （DDDs/100 persons bed days） by the dosage of the 8 kinds of β-lactamase inhibitor com- pounds, and using statistical methods to analyze the relationship between the dosage and efficacy. Results： 5 kinds of quality control bacteria have different drug resistances to β-lactamase inhibitor compound. The dosage of cefoperazone sodium, sulbactam sodium, and ticarcillin sodium clavulanate potassium and the drug resistance rate of Escherichia coli to ticarcillin sodium clavulanate potassium, piperacillin sodium and tazobactam sodium is positively correlated （P〈 0.05）. The dosage of ticarcillin sodium clavulanate potassium, piperacillin sodium and sulbactam sodium and the drug resistance rate ofAcinetobacter baumannii to mezlocillin sodium and sulbactam sodium is negatively correlated （P〈 0.05）. The dosage of cefoperazone sodium and sulbactam sodium and the drug resistance rate of Klebsiella pneumoniae to piperacillin sodium and sulbactam sodium, mezlocillin sodium and sulbactam sodium is positively correlated （P〈0.05）, and ticarcillin sodium clavulanate potassium, mezlocillin sodium and sulbactam sodium are negatively correlated to them （P〈0.05）. The dosage of amoxicillin sodium and sulbactam sodium and the drug resistance rate of Klebsiella pneumoniae to amoxicillin sodium and sulbactam sodium, the dosage of piperacillin sodium and sulbactam sodium and the drug resistance rate of Klebsiella pneumoniae to ticarcillin sodium clavulanate potassium, piperacillin sodium and tazobactam sodium are negatively correlated （P〈 0.05） respectively. The remaining data are not statistically significant. Conclusion： The rational use of β-lactamase inhibitor compound can slow down the emergence of bacterial drug resis- tance to a certain extent down.