ICU降阶梯治疗抗菌药物使用强度与细菌耐药率相关性分析

Correlation Analysis between the Intensity of Antibiotics Used in ICU Descending Treatment and Bacterial Resistance Rate

目的探讨ICU降阶梯治疗中主要抗菌药物使用强度与细菌耐药性的相关性,为合理选择抗菌药物提供参考。方法回顾性分析2013年3月-2018年12月在该院ICU住院患者的抗菌药物使用强度;采用K-B法检测同期ICU住院患者送检标本中分离的主要细菌的耐药率。结果共有45种抗菌药物纳入统计,合计使用强度为136.43,使用强度前十位的是头孢哌酮/舒巴坦(28.64)、氟康唑(26.64)、亚胺培南/西司他丁(25.46)、哌拉西林他唑巴坦(9.05)、万古霉素(6.77)、奥硝唑(5.84)、米诺环素(4.12)、头孢西丁(3.95)、左氧氟沙星(3.00)、莫西沙星(2.69);从各类标本中分离细菌730株,较常见的细菌是大肠埃希菌(149株,占20.41%)、肺炎克雷伯杆菌(110株,占15.07%)、铜绿假单胞菌(86株,占11.78%)、金黄色葡萄球菌(53株,占7.26%)、鲍曼不动杆菌(27株,占3.70%)。除左氧氟沙星使用强度与铜绿假单胞菌对左氧氟沙星的耐药率呈负相关外(r=-0.872,P=0.024),其余抗菌药物使用强度与细菌耐药率无显著相关。结论在使用降阶梯治疗策略的背景下,抗菌药物使用强度与细菌耐药性没有显著相关性。

Objective To investigate the correlation between the intensity of main antibacterial drugs and bacterial resistance in ICU descending therapy, and to provide a reference for rational selection of antibacterial drugs. Methods The antibacterial use intensity of inpatients in ICU from March 2013 to December 2018 was retrospectively analyzed.The K-B method was used to detect the resistance of major bacteria isolated from the ICU inpatients. Results A total of45 antibiotics were included in the statistics. The total intensity of use was 136.43. The top ten used were cefoperazone/sulbactam(28.64), fluconazole(26.64), and imipenem/cilastatin(25.46), piperacillin tazobactam(9.05), vancomycin(6.77), ornidazole(5.84), minocycline(4.12), cefoxitin(3.95), levofloxacin(3.00), moxisha(2.69);730 strains of bacteria were isolated from various specimens. The more common bacteria were Escherichia coli(149 strains, accounting for 20.41%), Klebsiella pneumoniae(110 strains, accounting for 15.07%), and patina Cytobacteria(86 strains,accounting for 11.78%), Staphylococcus aureus(53 strains, accounting for 7.26%), and Acinetobacter baumannii(27 strains, accounting for 3.70%). Except that the intensity of levofloxacin was negatively correlated with the resistance rate of P. aeruginosa to levofloxacin(r =-0.872, P =0.024), the intensity of other antibiotics was not significantly correlated with the rate of bacterial resistance. Conclusion In the context of the use of the descending treatment strategy, there was no significant correlation between the intensity of antimicrobial use and bacterial resistance.