我院大肠埃希氏菌、肺炎克雷伯菌耐药变迁的影响因素与AMS干预研究

The Study on Influence Factors of Drug Resistance Changes of Escherichia Coli and Klebsiella Pneumoniae and Intervention of Antimicrobial Stewardship in Our Hospital

目的:系统研究我院大肠埃希氏菌、肺炎克雷伯菌耐药性变迁与抗菌药物使用频度(DDDs)相关性,通过抗菌药物科学化管理(AMS),有效遏制细菌耐药。方法:以季度为统计时间段,采用回顾性分析方法,分别统计我院2016年1季度至2018年1季度大肠埃希氏菌、肺炎克雷伯菌耐药率和抗菌药物DDDs,通过SPSS 20.0统计学软件处理数据,分析其相关性及差异性。结果:大肠埃希氏菌耐药性与β-内酰胺酶抑制剂类、头霉素类抗菌药物DDDs呈高度正相关,相关系数(r)分别为0.81、0.82(P<0.05);与抗菌药物总DDDs呈中度正相关,r=0.72(P<0.05)。肺炎克雷伯菌与β-内酰胺酶抑制剂类抗菌药物DDDs呈高度正相关,r=0.80(P<0.05);与头霉素类及抗菌药物总DDDs呈中度正相关,r分别为0.69、0.71(P<0.05)。通过AMS干预后,β-内酰胺酶抑制剂类、头霉素类抗菌药物DDDs分别下降43.03%、28.63%,大肠埃希氏菌、肺炎克雷伯菌耐药率分别下降1.98%、3.98%。结论:我院大肠埃希氏菌、肺炎克雷伯菌耐药性与β-内酰胺酶抑制剂类、头霉素类抗菌药物DDDs有相关性,随着DDDs增加耐药率日渐增长,AMS干预使β-内酰胺酶抑制剂类、头霉素类抗菌药物DDDs下降,成效显著,同时大肠埃希氏菌、肺炎克雷伯菌耐药性得到有效控制。

Objective :To systematically study the correlation between drug resistance changes of Escherichia coli and Klebsiella pneumoniae and the defined daily doses (DDDs), through the antimicrobial stewardship (AMS),effectively curb bacterial drug resistance. Methods :Based on the quarterly statistical period, the retrospective analysis method was used to calculate the resistance rate of Escherichia coli and Klebsiella pneumoniae and antibacterial DDDs from the first quarter of 2016 to the first quarter of 2018. The data and the significance of difference analysis used the SPSS 20 software. Results : The drug resistance of Escherichia coli was highly correlated with the DDDs of enzyme inhibitors and cephamycins, and the correlation coefficient were 0.81 and 0.82( P< 0.05). The drug resistance of Escherichia coli was moderately positively correlated with the DDDs of antibiotics, and the correlation coefficient was 0.72( P< 0.05).The drug resistance of Klebsiella pneumoniae was highly correlated with the DDDs of enzyme inhibitors, and the correlation coefficient was 0.80( P< 0.05). The drug resistance of Klebsiella pneumoniae was moderately positively correlated with the DDDs of antibiotics and cephamycins, and the correlation coefficient were 0.69 and 0.71( P< 0.05). After intervention of antimicrobial stewardship in our hospital, the DDDs of β-lactamase inhibitors and cephamycins decreased by 43.03% and 28.63% respectively,and the drug resistance rates of Escherichia coli and Klebsiella pneumoniae decreased by 1.98% and 3.98% respectively. Conclusion : The drug resistance of Escherichia coli and Klebsiella pneumoniae is positively correlated with the DDDs of β-lactamase inhibitors and cephamycins. With the increase of DDDs, the rate of drug resistance is increasing.After intervention of antimicrobial stewardship in our hospital,the DDDs of β-lactamase inhibitors and cephamycins were decreased, and the drug resistance of Escherichia coli and Klebsiella pneumoniae was effectively controlled.