铜绿假单胞菌耐药性与抗菌药物使用强度的关系研究

Correlation Studies of Pseudomonas Aeruginosa Drug Resistance with the Antibiotics Use Intensity of Antibacterial Agents

目的分析铜绿假单胞菌耐药性和抗菌药物使用强度的相关性。方法选取2020年12月至2021年12月中国人民解放军陆军第八十三集团军医院收治的82例医院获得性铜绿假单胞菌感染患者为研究对象,采集患者的血液、痰液、尿液、分泌物或灌洗液标本进行病原菌培养和药敏试验,分析铜绿假单胞菌耐药性,统计患者抗菌药物使用强度,观察二者间的相关性。结果82例患者分离出的82株铜绿假单胞菌中,呼吸内科和重症监护室占比最高,分别为25.61%和20.73%,其次依次为神经外科(17.07%)、神经内科(12.20%)、骨科(8.54%)、急诊监护室(6.10%)、其他科室(8.54%)。在13种抗菌药物中铜绿假单胞菌对氨曲南和环丙沙星的耐药率最高,均在20%以上;对妥布霉素、头孢吡肟、美罗培南和阿米卡星的耐药率最低,均在10%以下。此外,13种抗菌药物中头孢他啶、氨曲南和左氧氟沙星使用强度(AUD)最高,大约在(10.04~10.59)DDDs/100人/d,头孢吡肟、美罗培南、阿米卡星和庆大霉素AUD最低,大约在(1.50~3.55)DDDs/100人/d。碳青霉烯类抗菌药物和第三代头孢类抗菌药物在2020年12月至2021年12月间整体AUD呈上升趋势;大环内酯类抗菌药物和第四代头孢类药物在研究期间整体AUD呈下降趋势;而其他类型的抗菌药物AUD则无明显变化。经相关性分析,仅碳青霉烯类抗菌药物和第三代头孢类抗菌药物的AUD与铜绿假单胞菌的耐药率呈正相关性,差异有统计学意义(r=0.589、0.642,均P<0.05);其他类型的抗菌药物AUD与铜绿假单胞菌的耐药率无相关性,差异无统计学意义(r值在-0.061~0.126,均P>0.05)。结论铜绿假单胞菌的耐药率与抗菌药物的AUD之间存在一定相关性,特别是碳青霉烯类抗菌药物和第三代头孢类抗菌药物,其AUD与铜绿假单胞菌耐药率之间呈正相关性,因此需重视对抗菌药物的管理,综合考虑病菌监测数据及药敏试验结果等因素慎重选择抗菌药物,以此降低铜绿假单胞菌耐药对人体健康造成的威胁。

Objective To study the correlation of pseudomonas aeruginosa drug resistance with the antibiotics use intensity of antibacterial agents.Methods A total of 82 patients with hospital-acquired pseudomonas aeruginosa infection treated in our hospital from December 2020 to December 2021 were chosen as research subjects.The blood,sputum,urine,secreta or lavage fluid specimens were obtained to take the pathogenic bacteria culture and drug sensitive test.The drug resistance of pseudomonas aeruginosa and the antibiotics use intensity of antibacterial agents were counted to observe its mutual relationships.Results A total of 82 pseudomonas aeruginosa strains were isolated,respiratory medicine and intensive care units had the highest proportion,with 25.61%and 20.73%,respectively,next by neurosurgery(17.07%),neurology(12.20%),Orthopedics(8.54%),emergency care(6.10%),and other departments(8.54%).Among 13 antibacterial agents,pseudomonas aeruginosa had the highest drug resistance of aztreonam and ciprofloxacin(>20%),the lower drug resistance of tobramycin,cefepime,meropenem and amikacin(<10%).In addition,among the 13 antimicrobial agents,the antibiotics use density(AUD)of ceftazidime,aztreonam and levofloxacin were higest,about(10.04~10.59)DDDs/100 people/d;AUD of cefepime,meropenem,amikacin and gentamicin were lowerist,about(1.50~3.55)DDDs/100 people/d.AUD of carbapenems antibacterial agent and third-generation cephalosporin antibacterial agent showed a rising tendency from December 2020 to December 2021;AUD of macrolides antibacterial agent and fourth-generation cephalosporin antibacterial agent showed a declining tendency in the study period;AUD of other antibacterial agents were not obviously changed.Correlation analysis showed that AUD of carbapenems antibacterial agent and third-generation cephalosporin antibacterial agent were positively correlated with the pseudomonas aeruginosa drug resistance(r=0.589,0.642;all P<0.05);ADU of other antibacterial agents were not correlated with the pseudomonas aeruginosa drug resistance(r=-0.061~0.126,all P>0.05).Conclusion Pseudomonas aeruginosa drug resistance is correlated with the AUD of antibacterial agents.In particular,AUD of carbapenems antibacterial agent and third-generation cephalosporin antibacterial agent is positively correlated with the pseudomonas aeruginosa drug resistance.Thus the antibacterial agent management should be focused.Antibacterial drugs should be carefully selected by considering the bacterial monitoring data and drug susceptibility test results,in order to reduce the health hazards induced by the pseudomonas aeruginosa drug resistance.