β-内酰胺类抗菌药物/β-内酰胺酶抑制剂复方制剂使用强度与常见革兰阴性菌耐药率关联性分析

Correlation Between the Use Density ofβ-Lactam/β-Lactamase Inhibitor Compound Preparation and the Drug Resistance Rate of Common Gram-Negative Bacteria

目的探讨β-内酰胺类抗菌药物/β内酰胺酶(β-内酰胺酶抑制剂复方制剂)使用强度与常见革兰阴性菌耐药率的关联性,为临床合理用药提供依据。方法回顾性分析2017年至2019年医院大肠埃希菌(ECO)、肺炎克雷伯菌(KPN)、铜绿假单胞菌(PAE)耐药性变迁情况,以及哌拉西林舒巴坦(PIS)、哌拉西林他唑巴坦(TZP)、头孢哌酮舒巴坦(CSL)在全院平均水平的使用强度(AUD),采用Spearman秩相关检验分析上述药物耐药性与抗菌药物使用强度的关联情况。结果大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌的平均检出率分别为20.47%,18.38%,5.85%。哌拉西林他唑巴坦的AUD与大肠埃希菌对亚胺培南(R=-0.713)及美罗培南(R=-0.766)的耐药率均呈负相关(P<0.05);哌拉西林舒巴坦的AUD与大肠埃希菌对复方新诺明的耐药率呈正相关(R=-0.738,P<0.05);头孢哌酮舒巴坦的AUD与大肠埃希菌对阿米卡星(R=0.680)及与铜绿假单胞菌对哌拉西林舒巴坦(R=0.670)的耐药率均呈正相关(P<0.05);头孢哌酮舒巴坦的AUD与肺炎克雷伯菌对氨苄西林舒巴坦(R=-0.612)、头孢唑林(R=-0.687)、头孢他啶(R=-0.615)、头孢曲松(R=-0.708)、庆大霉素(R=-0.609)、环丙沙星(R=-0.666)的耐药率均呈负相关(P<0.05)。结论哌拉西林舒巴坦、哌拉西林他唑巴坦、头孢哌酮舒巴坦的AUD与大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌对某些抗菌药物的耐药性具有显著相关性。

Objective To investigate the correlation between the use intensity ofβ-lactam/β-lactamase inhibitor compound preparation and the drug resistance rate of common Gram-negative bacteria,so as to provide a basis for clinical rational drug use.Methods The resistance changes of Escherichia coli(ECO),Klebsiella pneumonia(KPN)and Pseudomonas aeruginosa(PAE)isolated from 2017 to 2019 by clinical laboratory and the antibiotics use density(AUD)of piperacillin sulbactam(PIS),the mean use density of piperacillin tazobactam(TZP)and cefoperazone sulbactam(CSL)at hospital level were retrospectively analyzed,and the correlation between the above two kinds of changes were analyzed by Spearman rank.Results The average detection rates of ECO,KPN and PAE were 20.47%,18.38%and 5.85%,respectively.The AUD of TZP was negatively correlated with the drug resistance rate of ECO to imipenem(R=-0.713,P<0.05)and meropenem(R=-0.766,P<0.05),the AUD of PIS was positively correlated with the drug resistance rate of ECO to cotrimoxazole(R=-0.738,P<0.05),the AUD of CSL was negatively correlated with the drug resistance rate of ECO to amikacin(R=0.680,P<0.05)and PAE to TZP(R=0.670,P<0.05).However,the AUD of CSL was negatively correlated with the drug resistance rate of KPN to ampicillin(R=-0.612,P<0.05),ceftazolin(R=-0.687,P<0.05),ceftazidine(R=-0.615,P<0.05),ceftriaxone(R=-0.708,P<0.05),gendamycin(R=-0.609,P<0.05)and ciprofloxacin(R=-0.666,P<0.05).Conclusion The AUD of PIS,TZP and CSL were significantly correlated with the drug resistance of ECO,KPN and PAE to some antibacterial drugs.