2013-2016年抗菌药物使用频度对肺炎克雷伯菌耐药率影响分析

Analysis the influence of antimicrobial use frequency on Klebsiella pneumoniae resistance from2013to2016

目的了解医院近几年抗菌药物使用情况及对超广谱β-内酰胺酶(ESBLS)阴性肺炎克雷伯菌和阳性肺炎克雷伯菌耐药的影响,为临床合理使用抗菌药物,降低细菌耐药率提供指导依据。方法统计该院2013-2016年常用抗菌药物使用频度和强度及同期分离的肺炎克雷伯菌耐药情况进行回顾性调查分析。结果医院抗菌素使用强度(AUD)从2013-2015年逐年上升,从23.16至44.44,上升了47.88%。2016年有所下降为42.76,下降3.78%。肺炎克雷伯菌对常用抗菌药物的耐药率不断上升,特别是对碳青霉烯类抗菌素耐药率呈上升趋势。抗菌药物使用频度(DDDS)分析,ESBLS阴性肺炎克雷伯菌耐药率与美洛培南使用频度呈高度相关性,有显著统计学意义(r=0.992,P=0.008),与左氧氟沙星高度相关(r=0.899),与庆大霉素、头孢曲松、头孢吡肟、氨曲南和头孢哌酮/舒巴坦有一定相关性。ESBLS阳性克雷伯菌耐药率与头孢他啶和亚胺培南使用频度呈高度的相关性(r=0.965,P=0.035)和(r=0.907,P=0.048),与左氧氟沙星、头孢哌酮/舒巴坦和氨曲南有一定相关性。结论抗菌药物使用强度和频度与细菌耐药率有一定的相关性,必须加强抗菌药物管理,合理使用抗菌药物,才能更好地降低细菌耐药率和耐药细菌的产生。

Objective The use of antibiotics in hospitals and the effects of extended-spectrumβ-lactamase(ESBLS)negative Klebsiella pneumoniae and positive Klebsiella pneumoniae in recent years will provide guidance to the rational use of antibiotics in clinical practice and reduce the rate of bacterial resistance.Methods Summarizing the frequency and intensity of antibiotics commonly used and the drug resistance of Klebsiella pneumoniae isolated from the same period in the hospital from2013to2016,to process retrospective investigation and analysis.Results Hospital antibiotic use intensity(AUD)increased from2013to2015year by year,a47.88%increase from23.16to44.44.A3.78%decrease in2016drop to42.76.the resistance to commonly used antimicrobial agents to Klebsiella pneumoniae showed an upward trend.especially to carbapenem showed an upward trend.By analyzing the Antimicrobial use frequency(DDDS),the efficacy of ESBLS-negative Klebsiella pneumoniae was significantly correlated with meropenem which have obviously statistical significance(r=0.992,P=0.008),and was significantly correlated with levofloxacin(r=0.899),and have someway relevance with gentamicin,Ceftriaxone,cefepine,aztreonam,cefoperazone/sulbactam.The resistance rate of ESBLS-positive Klebsiella pneumoniae was highly correlated with the frequency of ceftazidime and imipenem which was statistically significant(r=0.965,P=0.035)and(r=0.907,P=0.048),and have somewhat relevance with levofloxacin,cefoperazone/sulbactam and aztreonam.Conclusion In order to effectively reduce bacterial resistance and drug-resistant bacteria,the management of antimicrobial drugs must be strengthen and rational use of antibiotics as Antimicrobial drug use strength and frequency and bacterial resistance rate have certain relevance.