鲍曼不动杆菌耐药性变迁与抗菌药物使用变迁的相关性分析

Correlation Analysis Between Changes of Drug Resistance of Acinetobacter Baumannii and Changes of Antibiotic Use

目的:分析抗菌药物使用情况与鲍曼不动杆菌耐药性之间的联系,为抗菌药物的使用提供依据。方法:统计并分析2016年至2020年期间宜春市人民医院住院患者使用的抗菌药物数据,计算出各抗菌药物的使用频数、构成比、使用强度和鲍曼不动杆菌对抗菌药物的耐药率,并对抗菌药物的使用频数、使用结构、使用强度与鲍曼不动杆菌耐药率变迁作相关性分析。结果:2016年至2017年,抗菌药物总DDDs值呈现上升趋势。2017年至2020年,总DDDs值呈现下降趋势,总值在30万附近波动。头孢菌素类药物构成比最高,占据一半以上。2016年至2020年期间,抗菌药物AUD值在22附近呈现不规则上下浮动,2018年AUD值最高为24.04,其中左氧氟沙星使用强度最高,头孢他啶其次。从2016年至2020年鲍曼不动杆菌对抗菌药物的耐药率多数呈现上升趋势,少数为波动变化,其中对亚胺培南、头孢曲松和环丙沙星耐药率连续五年都超过了50%。头孢菌素类、大环内酯类和喹诺酮类抗菌药物的DDDs与鲍曼不动杆菌耐药率为负相关关系,青霉素类DDDs与鲍曼不动杆菌耐药率为正相关关系;各类抗菌药物的构成比与鲍曼不动杆菌耐药率均为正相关关系;亚胺培南、头孢哌酮舒巴坦的AUD与鲍曼不动杆菌耐药率为正相关关系,头孢曲松与鲍曼不动杆菌耐药率为负相关关系,其余主要抗菌药物均与鲍曼不动杆菌耐药率均为正相关关系。结论:在使用各类抗菌药物进行抗感染治疗时,需要根据鲍曼不动杆菌耐药率的耐药性的变化规律进一步规范抗菌药物的使用,以避免高耐药性的产生。

Objective:To analyze the relationship between antimicrobial use and drug resistance of Acinetobacter baumannii,so as to provide evidence for the use of antimicrobial agents.Methods:The data of antibacterial drugs used by hospitalized patients in Yichun People’s Hospital from 2016 to 2020 were statistically analyzed,the frequency of use,structure of use,intensity of use of each antibacterial drug and the resistance rate of different bacilli to antibacterial drugs were calculated,and the correlation analysis was made between the frequency of use,structure of use,intensity of use of antibacterial drugs and the change of resistance rate of acinetobacter baumannii.Results:From 2016 to 2017,the total DDDs values of antibacterial drugs showed an increasing trend,and from 2017 to 2020,the total DDDs values showed a decreasing trend,with a total value fluctuating around 300000 yuan.Cephalosporins have the highest constituent ratio,accounting for half and more.During the period from 2016 to 2020,the AUD value of antibacterial drugs showed an irregular fluctuation around 22,with the highest AUD value of 24.04 in 2018,of which levofloxacin had the highest intensity of use,followed by ceftazidime.From 2016 to 2020,the resistance rates of acinetobacter baumannii to antibacterial drugs mostly showed an increasing trend,and a few showed fluctuating changes,of which the resistance rates to imipenem,ceftriaxone and ciprofloxacin exceeded 50%for five consecutive years.The DDDs of cephalosporins,macrolides and quinolones were negatively correlated with the drug resistance of acinetobacter baumannii,and the DDDs of penicillins were positively correlated with the drug resistance of acinetobacter baumannii.The constituent ratios of various antibacterial drugs were positively correlated with the drug resistance of acinetobacter baumannii.The AUD of imipenem and cefoperazone sulbactam was positively correlated with the drug resistance of acinetobacter baumannii,the ceftriaxone was negatively correlated with the drug resistance of acinetobacter baumannii,and the other main antibacterial drugs were positively correlated with the drug resistance of acinetobacter baumannii.Conclusion:In order to avoid the occurrence of high drug resistance,it is necessary to further standardize the use of antibacterial drugs according to the change rule of drug resistance rate of acinetobacter baumannii in anti-infection treatment with various antibacterial drugs.