2012—2016年益阳市中心医院大肠埃希菌耐药性变迁及其与抗菌药物用药频度、使用强度的相关性分析

摘要

目的:了解益阳市中心医院(以下简称"该院")2012—2016年大肠埃希菌的耐药性变迁趋势,探讨其与抗菌药物的用药频度(defined daily dose system,DDDs)、使用强度(antibiotics use density,AUD)的相关性,为临床合理用药提供参考.方法:回顾性分析2012—2016年该院大肠埃希菌的耐药率变化及同期抗菌药物DDDs、AUD,并分析耐药率与DDDs及AUD之间的相关性.结果:2012—2016年,该院大肠埃希菌的年检出率分别为18.13％(874/4822)、20.78％(1183/5692)、20.41％(947/4639)、23.88％(752/3149)和22.96％(750/3266),呈逐渐上升趋势;产超广谱β-内酰胺酶大肠埃希菌的检出率均<57.5％.该院大肠埃希菌对氨苄西林、头孢唑林的耐药率高,对左氧氟沙星、头孢他啶等的耐药率较高,但总体对常见抗菌药物的耐药率呈逐年下降趋势.2012—2016年,该院左氧氟沙星、头孢哌酮舒巴坦及哌拉西林他唑巴坦的DDDs排序均居前3位,皮尔选相关系数r分别为-0.129、-0.609和-0.709;左氧氟沙星、头孢哌酮舒巴坦及哌拉西林他唑巴坦的AUD也较高,r分别为0.329、-0.282和-0.600.结论:该院大肠埃希菌的耐药趋势得到了一定的遏制,抗菌药物的使用进入细节规范化阶段,需继续加强抗菌药物的全程使用干预,使抗菌药物的使用达到效益最大化,并延缓细菌耐药性的发展,促进合理用药.%OBJECTIVE:To understand the drug-resistance evolution of Escherichia coli( E.coli) and correlation with defined daily dose system ( DDDs) and antibiotics use density ( AUD) of antibiotics in Yiyang Central Hospital ( Hereinafter referred to as "the hospital") during 2012-2016 , so as to provide reference for the rational drug application in clinic .METHODS:Retrospective analysis was conducted on the changes of drug resistance rate of E. coli and the situation of DDDs and AUD in the same period during 2012-2016 , and the correlation between drug resistance rate and DDDs and AUD were analyzed .RESULTS:During 2012-2016, the annual inspection of E.coli in the rate were 18.13％(874/4822 strain) , 20.78％(1183/5692 strain) , 20.41％(947/4639 strain) , 23.88％(752/3149 strain) and 22.96％(750/3266 strain), and which were in an increasing tendency .The detection rate of ESBL <57.5％.The E.coli to ampicillin and cefazolin showed higher resistance rate , and to levofloxacin , ceftazidime showed relatively high resistance rate , yet the overall data showed a downward trend year by year .During 2012-2016, the DDDs of levofloxacin, cefoperazone sulbactam and piperacillin tazobactam dominated the top 3 places, the r were respectively -0.129, -0.609 and -0.709.The AUD of levofloxacin, cefoperazone sulbactam and piperacillin tazobactam were relatively high , the r were respectively 0.329, -0.282 and -0.600.CONCLUSIONS:The tendency of antibiotic resistance in E.coli of the hospital has been checked , the application of antibiotics become more standard .It is necessary to strengthen the intervention on the whole application of antibiotics , so as to achieve the maximum efficiency , delay the development of bacterial resistance , and promote the rational application of drugs .