4种常见碳青霉烯类耐药革兰氏阴性杆菌检出率与抗菌药物使用强度的相关性研究

Correlation between detection rate of 4 common carbapenem-resistant organism and antimicrobial use density

目的探讨本院4种常见碳青霉烯类耐药革兰氏阴性杆菌(CRO)检出率与抗菌药物使用强度(AUD)的相关性,为降低其耐药性和促进临床合理使用抗菌药物提供参考。方法收集和统计2012—2019年度广西某综合性三级甲等医院住院病区抗菌药物的使用情况,监测4种常见革兰氏阴性杆菌对碳青霉烯耐药率的变迁情况,采用Pearson相关方法分析4种常见CRO检出率与抗菌药物使用强度的相关性。结果2012—2019年4种常见CRO的各年度检出率均无明显变化趋势。其中耐碳青霉烯大肠埃希菌(CRECO)的检出率与莫西沙星、多西环素的使用强度成正相关(P均<0.05);耐碳青霉烯肺炎克雷伯菌(CRKPN)的检出率与环丙沙星的使用强度成负相关(P均<0.05);耐碳青霉烯铜绿假单胞菌(CRPAE)的检出率与亚胺培南和头孢哌酮舒巴坦的使用强度成正相关(P均<0.05),而与环丙沙星的使用强度成负相关(P均<0.05);耐碳青霉鲍曼不动杆菌(CRAB)的检出率与亚胺培南、头孢哌酮舒巴坦和多西环素的使用强度成正相关(P<均0.05)。结论CRO的检出率与抗菌药物使用强度息息相关,临床诊治中需要加强抗菌药物合理使用的管控,减少细菌耐药性的产生,改善不断恶化的临床多重耐药菌或广泛耐药菌感染形势。

Objective To determine the correlation between detection rate of 4 common carbapenem-resistant organism(CRO)and antimicrobial use density(AUD)to reduce drug resistance and provide reference for reasonable antibiotics use.Methods AUD of antibacterial drugs commonly used in the inpatient sections of a comprehensive 3A hospital in Guangxi from 2012 to 2019 was collected.The 4 common CROs were constantly monitored,and Pearson correlation was used to analyze the correlation between the dection rate of 4 common CRO and AUD.Results The annual detection rates of 4 common CRO showed no significant change from 2012 to 2019.The detection rate of carbapenem resistant Escherichia coli was positively correlated with the AUD of moxifloxacin and doxycycline(P<0.05).The detection rate of carbapenem resistant Klebsiella pneumoniae was negatively correlated with the AUD of ciprofloxacin(P<0.05).The detection rate of carbapenem resistant Pseudomonas aeruginosa was positive correlated with antimicrobial use density of imipenem and cefoperazone/sulbactam(P<0.05),but negatively with that of ciprofloxacin(P<0.05).The detection rate of carbapenem resistant Acinetobacter baumannii was positively correlated with the AUD of imipenem,cefoperazone/sulbactam and doxycycline(P<0.05).Conclusion The detection rates of CRO are closely related to the AUD.It is necessary to control the use of antibiotics,to reduce antimicrobial resistance.