某院2017-2021年β-内酰胺酶抑制剂复方制剂使用强度与革兰阴性菌耐药趋势及相关性分析

Correlations between Usage ofβ-lactamase Inhibitor Compound Preparations and Drug Resistance of Gram-negative Bacteria in a Hospital from 2017 to 2021

目的研究β-内酰胺酶抑制剂复方制剂使用强度与革兰阴性菌耐药的关联性和变化趋势,为临床合理用药及管控提供参考。方法回顾性分析2017-2021年某院的大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌的耐药性变化情况及同期β-内酰胺酶抑制剂复方制剂使用强度。采用线性回归分析β-内酰胺酶抑制剂复方制剂使用强度及菌株的检出率、耐药率变化趋势,采用Spearman分析评价使用强度与细菌耐药率的相关性。结果β-内酰胺酶抑制剂复方制剂使用强度呈逐年上升趋势(P<0.05)。大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌平均检出率分别为21.97%、16.84%、5.24%、3.41%。大肠埃希菌对亚胺培南,肺炎克雷伯菌对亚胺培南、哌拉西林他唑巴坦及铜绿假单胞菌对美罗培南、环丙沙星的耐药率均呈上升趋势(P<0.05)。大肠埃希菌对亚胺培南,肺炎克雷伯菌对亚胺培南、美罗培南、哌拉西林他唑巴坦、阿米卡星,铜绿假单胞菌对美罗培南、环丙沙星及鲍曼不动杆菌对头孢哌酮舒巴坦的耐药率均与β-内酰胺酶抑制剂复方制剂使用强度呈正相关(P<0.05)。此外,大肠埃希菌对氨苄西林的耐药率与β-内酰胺酶抑制剂复方制剂使用强度呈负相关(P<0.05)。结论β-内酰胺酶抑制剂复方制剂使用强度与大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌的耐药率具有显著相关性,应加强监管,严格掌握β-内酰胺酶抑制剂复方制剂应用指征,以减少抗菌药物不合理应用,减少细菌耐药。

Objective To analyse the correlations between the usage ofβ-lactamase inhibitor compound prep-arations(BL/BLI)and drug resistance of Gram-negative bacteria(G-)in order to provide reference for clinical rational drug use and control.Methods The changes of drug resistance of Escherichia coli(EC),Klebsiella pneumoniae(KP),Pseudomonas aeruginosa(PA),and Acinetobacter baumannii(AB)and the usage of BL/BLI in our hospital between 2017 and 2021 were retrospectively analyzed.Linear regression was used to analyze the usage of BL/BLI,detection rate and resistance rate of strains.Spearman correlation analysis was used to reveal the correlations between the usage of BL/BLI and bacterial resistance rates.Results The usage of BL/BLI increased year by year(P<0.05).The aver-age detection rates of EC,KP,PA and AB were 21.97%,16.84%,5.24%,and 3.41%,respectively.The resistance rates of EC to Imipenem,KP to Imipenem and Piperacillin tazobactam,and PA to Meropenem and Ciprofloxacin tren-ded up(P<0.05).The resistance rates of EC to Imipenem,KP to Imipenem,Meropenem,Piperacillin tazobactam,and Amikacin,PA to Meropenem and Ciprofloxacin,and AB to Cefoperazone sulbactam were positively correlated with the usage of BL/BLI(P<0.05),but the drug resistance rate of EC to Ampicillin was negatively correlated(P<0.05).Conclusion The usage of BL/BLI is significantly correlated with drug resistance rates of EC,KP,PA,and AB.Supervision is critical,and the indications of BL/BLI should be strictly controlled to reduce irrational use of antibiotics and minimize bacterial resistance.