肠杆菌科细菌耐药性与抗生素使用量的相关性

The correlation between antimicrobial resistance and antimicrobial consumption in Enterobacteriaceae

目的探讨肠杆菌科细菌耐药性及其与抗生素使用量间的相关性,为临床合理用药提供依据。方法对上海市第一人民医院2011年1月-2015年12月临床分离的肠杆菌科细菌进行药敏试验,统计抗生素使用强度(AUD)。采用SPSS16.0统计分析细菌耐药性与AUD的相关性。结果 5年间,共分离肠杆菌科细菌5 515株,分离率逐年升高,差异有统计学意义(P<0.05),其中碳青霉烯耐药肠杆菌科细菌(CRE) 116株,检出率各年间较为稳定(均<3%),以肺炎克雷伯菌和大肠埃希菌为主。肠杆菌科细菌对哌拉西林的耐药率最高(56.4%),其次为环丙沙星(48.4%);对亚胺培南(1.7%)及美罗培南(1.5%)的耐药率最低,5年间无显著变化;对哌拉西林、哌拉西林/他唑巴坦、头孢他啶、头孢吡肟、阿米卡星及环丙沙星的耐药率逐年下降,差异有统计学意义(P<0.05)。CRE菌株对常用抗生素的耐药性明显高于碳青霉烯类敏感的肠杆菌科细菌(CSE)。在CRE中亚胺培南的使用量与其耐药率呈正相关(r=0.880,P<0.05)。结论CRE菌株的耐药性较强,临床上应关注亚胺培南的适量使用。

Objective To explore the trends and relationship between antibiotic resistance and antibiotic consumption in Enterobacteriaceae,and provide a basis for the clinical rational use of antimicrobial agents.Methods Susceptibility of antibiotics for the Enterobacteriaceae isolates from clinical samples was detected,and counted the antibiotics use density(AUD) during January 2011 to December 2015 in our hospital.The analysis of antimicrobial resistance prevalence,and tendencies and correlations between antimicrobial resistance and AUD was conducted by SPSS 16.0 software.Results A total of 5 515 strains of Entero bacteriaceae were identified within 5 years,and the isolation rate showed a significantly increasing trend year by year(P<0.05).Carbapenem resistance Enterobacteriaceae(CRE) was found in 116 isolates with a <3% stable resistance rate in each year,and Klebsiella pneumonia and Escherichia coli were the main species.For all Enterobacteriaceae,the resistance rate to piperacillin was the highest(56.4%),followed by ciprofloxacin(48.4%).The low stable resistance rates of imipenem(1.7%) and meropenem(1.5%) were found during 5 years;nevertheless,the resistance rates of piperacillin,piperacillin/tazobartan,ceftazidine,cefepime,amikacin and ciprofloxacin showed a decreasing trend year by year(P<0.05).The resistance rates of CRE to antimicrobial agents were significantly higher than those of carbapenem-sensitive Enterobacteriaceae(CSE).The consumption of imipenem was positively correlated(r=0.880,P<0.05) with its resistance in CRE.Conclusion The resistance of CRE was strong,and more attention should be paid to the rational use of imipenem in clinical practice.