摘要
目的了解2011-2016年某老年病医院鲍氏不动杆菌耐药性和抗菌药物使用强度变化趋势及二者间相关性,为临床合理使用抗菌药物提供依据。方法采用回顾性分析方法,汇总2011-2016年住院患者分离的鲍氏不动杆菌耐药性及同期抗菌药物使用强度,应用SPSS20.0统计软件进行数据整理,Spearman秩相关进行相关性分析。结果临床分离鲍氏不动杆菌药敏分析表明,2011-2016年鲍氏不动杆菌对绝大部分抗菌药物耐药率逐年上升,对头孢吡肟、头孢他啶耐药率持续升高,分别由2011年的72.36%、76.02%,增加到2016年的81.72%、83.60%(χ~2=16.460,24.180,P<0.05);对亚胺培南的耐药率2011年和2016年分别为72.13%和77.42%(χ~2=6.010,P<0.05);对左氧氟沙星的耐药率由2011年的70.15%,增加到2016年的79.57%(χ~2=11.88,P<0.05);对磺胺甲噁唑/甲氧苄啶的耐药率由2011年的22.34%增加到2016年耐药率56.99%(χ~2=232.340,P<0.01);对头孢哌酮/舒巴坦耐药率未发生明显变化;青霉素类和头孢菌素类使用强度呈逐年下降趋势,碳青霉烯类和喹诺酮类使用强度呈逐年上升趋势。其他药物使用强度变化不大;鲍氏不动杆菌对头孢吡肟耐药率与头孢菌素类尤其是四代头孢菌素类使用强度相关(r=0.829、0.928,P<0.05),与碳青霉烯类药物使用强度也呈现相关性(r=0.943,P<0.05),鲍氏不动杆菌对左氧氟沙星耐药率与喹诺酮类药物的使用强度相关(r=0.829,P<0.05),对亚胺培南的耐药率与碳青霉烯类药物使用强度相关(r=0.851,P<0.05),与四代头孢菌素使用强度相关(r=0.841,P<0.05)。结论本院鲍氏不动杆菌耐药率不断升高,耐药率的升高和抗菌药物大量使用密切相关。喹诺酮类不适用于鲍氏不动杆菌的感染治疗,碳青霉烯类的使用须严格掌握适应证,头孢哌酮/舒巴坦可用于联合用药治疗。
OBJECTIVE To understand the correlation between the drug resistance of Acinetobacter baumannii strains isolated from a geriatric hospital in 2011-2016 and the use intensity of antibiotics so as to provide guidance for reasonable clinical use of antibiotics.METHODS By means of retrospective survey,the drug resistance rates of the A.baumannii strains isolated from the patients who were hospitalized from 2011 to 2016 and the use intensity of antibiotics were summarized,the data were statistically analyzed by using SPSS20.0 software,and the Spearman correlation analysis was performed for the correlation between the drug resistance and the use intensity of antibiotics.RESULTS The result of drug susceptibility testing for the clinical isolates of A.baumannii indicated that the drug resistance rates of the A.baumannii strains to most of the antibiotics were increased year by year in2011-2016,the drug resistance rates to cefepime and ceftazidime showed upward trends,increasing from 72.36%and 76.02%in 2011 to 81.72% and 83.60%in 2016（χ2=6.460,24.180,P〈0.05）;the drug resistance rate to imipenem was 72.13%in 2011,77.42%in 2016（χ2=.010,P〈0.05）;the drug resistance rate to levofloxacin was increased from 70.15%in 2011 to 79.57%in 2016（χ2=1.88,P〈0.05）;the drug resistance rate to compound sulfamethoxazole was increased from 22.34%in 2011 to 56.99%in 2016（χ2=32.340,P〈0.01）;the drug resistance rate to cefoperazone-sulbactam did not change significantly.The use intensities of penicillins and cephalosporins were decreased year by year,the use intensities of carbapenems and quinolones were increased year by year,and the use intensities of other antibiotics did not change significantly.The drug resistance rate of the A.baumannii strains to cefepime was associated with the use intensity of cephalosporins,especially the fourth generation of cephalosporins（r=0.829,0.928,P〈0.05）,and was associated with the use intensity of carbapenems（r=0.943,P〈0.05）.The drug resistance rate of the A.baumanni strain
作者
祝丙华
赵强
张蓉
于旭红
张金萍
ZHU Bing-hua;ZHAO Qiang;ZHANG Rong;YU Xu-hong;ZHANG Jin-ping(305 Hospital of PLA,Beijing 100017,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2018年第18期2740-2743,共4页
Chinese Journal of Nosocomiology
基金
院科研青年基金资助项目(16YNQN09)
关键词
老年病医院
鲍氏不动杆菌
耐药率
使用强度
相关性
Geriatric hospital
Acinetobacter baumannii
Drug resistance rate
Use intensity
Correlation
