烧伤病区抗生素使用与铜绿假单胞菌耐药水平变化的关系

Relationship between administration of antibiotics and resistance rate of Pseudomonas aeruginosa in a burn unit

目的研究烧伤病区抗生素的使用与铜绿假单胞菌的耐药水平变化之间的关系,为防治烧伤病区铜绿假单胞菌的感染提供依据。方法计算8年来烧伤病区各类抗生素的累积每日约定剂量(DDD)和平均每日每百张床位所消耗的DDD数,以及同期导致烧伤感染的铜绿假单胞菌对8种抗生素的耐药水率,并对抗生素的使用量与耐药率进行相关分析。结果8年来烧伤病区使用的抗感染药物中,氨基糖苷类、第一代头孢菌素等抗生素的使用量大幅度下降,而碳青霉烯类、大环内酯类和含酶抑制剂类抗生素使用量的上升幅度较大;同期铜绿假单胞菌对多种抗生素的耐药率有明显的变化。与之相对应,铜绿假单胞菌对亚胺培南的耐药率分别与大环内酯类、碳青霉烯类和第三代头孢菌素的使用量呈正相关,而该菌对环丙沙星和哌拉西林的耐药率分别与第三代头孢菌素和含酶抑制剂类(INH)抗生素的使用量密切相关,其中与INH的相关系数为负值。结论结果提示,广谱抗生素的使用对铜绿假单胞菌耐药的水平影响较大;在烧伤临床抗感染治疗中减少碳青霉烯和第三代头孢菌素的使用、加大含酶抑制剂类抗生素的使用量有可能降低铜绿假单胞菌的耐药水平。

Objective To investigate the relationship between administration of a ntibiotics and the resistance rate of P.aeruginosa in a burn unit.Methods The da ta of different kind of antibiotics therapeutic dose and also the total antibiot ic consumption expressed as defined daily doses (DDD)/day/100bed]as well as res istance rate of P.aeruginosa were collected in an 8 year period, and their corr elation was analyzed.Results Within this period, it was found that the consumpti on of aminoglycosides and first generation cephalosporins were declined graduall y,while the consumption of carbopenem,macrolides and the use of antibiotic plus β lactamase inhibitor preparations were increased.Meanwhile,the resistance ra tes of P.aeruginosa changed markedly.The resistance rates of P.aeruginosa were c losely correlated to the consumption of macrolides,antibiotic plus β-lactamase inhibitor preparations, carbopenems,as well as the third generation cephalospo rins.Conclusions The results suggested that the therapeutic dose of different br oad spectrum antibiotics might change the resistance rates of P.aeruginosa,decre ase of the consumption of carbopenems and the third generation cephalosporins an d increase the consumption of compound preparation might reduce the resistance r ate of P.aeruginosa in treatment of burn infections.