本院2014-2017年抗菌药物应用与细菌耐药率的相关性分析

Association between use of antibiotics and bacterial resistance in our hospital during 2014-2017

目的探讨本院抗菌药物使用频度(DDDs)与细菌耐药率的相关性,以期为临床合理应用抗菌药物提供参考。方法采用回顾性调查方法,统计本院2014年1月-2017年12月抗菌药物用药频度(DDDs)及同期细菌耐药率,并利用SPSS统计软件考察两者的相关性。结果本院2014-2017年抗菌药物DDDs排名前3位的依次为含β-内酰胺酶抑制剂类、头孢菌素类及喹诺酮类;细菌检出率排名前5位的菌株包括大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌和金黄色葡萄球菌。阿奇霉素的DDDs与金黄色葡萄球菌的耐药率存在显著正相关(r=0.952,P <0.05),哌拉西林他唑巴坦的DDDs与大肠埃希菌的耐药率呈显著正相关(r=0.968,P <0.05),头孢哌酮舒巴坦的DDDs与鲍曼不动杆菌的耐药率呈显著正相关(r=0.958,P <0.05),阿米卡星的DDDs与肺炎克雷伯菌的耐药率呈显著负相关(r=-0.989,P <0.01)。结论抗菌药物DDDs与细菌耐药率存在一定的相关性,应加强抗菌药物的监督管理及细菌耐药监测,以减少细菌耐药的发生。

Objective To analyze the association between the use of antibiotics and bacterial resistance in our hospital and provide evidences for rational use of antibiotics. Methods The defined daily doses （DDDs） of antibiotics and resistance rate of common pathogens were counted retrospectively from Jan 2014 to Dec 2017,and the relationship between them was analyzed by SPSS 19.0. Results During Jan 2014 to Dec 2017, DDDs of the top 3 antibiotics in our hospital included fl-lactamase inhibitors, cephalosporins, and quinolones. Bacteria with the top 5 detection rate covered Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Staphylococcus aureus. The DDD of azithromycin showed a positive correlation with the resistance rate of Staphylococcus aureus （r = 0.952, P 〈 0.05）; DDD of piperacillin sodium and tazobactam sodium showed a positive correlation with the resistance rate of Escherichia coli （r = 0.968, P 〈 0.05）; DDD of sulbactam and cefopcrazone showed a positive correlation with the resistance rate of Acinetobacter baumannii （r = 0.958, P 〈 0.05）; but DDD of amikacin showed a negative correlation with the resistance rate of Klebsiella pneumoniae （r = - 0.989, P 〈 0.01）. Conclusion Positive correlation has been found between the DDDs of antibiotics and bacterial resistance. Monitoring of bacterial resistance and management of antibiotics can reduce the incidence of bacterial resistance.