2016-2017年同济大学附属东方医院碳青霉烯类抗菌药物用药频度与肺炎克雷伯菌耐药率的相关性分析

摘要

目的:探讨同济大学附属东方医院(以下简称"该院")碳青霉烯类抗菌药物用药频度(defined daily dose system,DDDs)与肺炎克雷伯菌耐药率的相关性,为临床合理应用碳青霉烯类药物提供参考.方法:采用回顾性调查方法,按季度统计2016-2017年该院碳青霉烯类药物DDDs及其占抗菌药物总DDDs的比例、肺炎克雷伯菌对碳青霉烯类药物耐药率和耐碳青霉烯类肺炎克雷伯菌的临床科室分布情况,应用SPSS 17.0统计软件包处理数据,采用Spearman相关法,对碳青霉烯类抗菌药物DDDs占抗菌药物总DDDs的比例与肺炎克雷伯菌耐药率进行相关性分析.结果:2016-2017年该院各季度碳青霉烯类抗菌药物DDDs占抗菌药物总DDDs的比例分别为5.9％、7.8％、6.6％、8.1％、8.1％、8.1％、8.8％及7.3％;分离出的耐碳青霉烯类肺炎克雷伯菌主要分布于中心监护室、急诊内科病房和神经外科等;肺炎克雷伯菌对碳青霉烯类抗菌药物的耐药率与碳青霉烯类抗菌药物DDDs占抗菌药物总DDDs的比例呈正相关.结论:碳青霉烯类抗菌药物的DDDs对肺炎克雷伯菌的耐药率变化影响较大,需加强对其临床应用的监控.%OBJECTIVE: To probe into the correlation between defined daily dose system (DDDs) of carbapenem antibiotics and drug resistance rate of Klebsiella pneumoniae in Dongfang Hospital Affiliated to Tongji University (hereinafter referred to as "the hospital"), so as to provide reference for clinical rational application of carbapenems. METHODS: Retrospective survey was conducted to make quarterly statistics on the DDDs of carbapenems drugs and the proportion to the total DDDs of antibiotics, the drug resistance rate of Klebsiella pneumoniae to carbapenems drugs and the distribution of clinical departments of Klebsiella pneumoniae resistant to carbapenems in the hospital during 2016-2017. The SPSS 17.0 statistical software package was used to process the data. Spearman correlation method was used to analyze the correlation between the ratio of DDDs of carbapenem antibiotics to the total DDDs of antibiotics and the resistance rate of Klebsiella pneumoniae. RESULTS: During 2016-2017, the ratio of DDDs of carbapenem antibiotics to total DDDs of antibiotics in each quarter was 5.9％, 7.8％, 6.6％, 8.1％, 8.1％, 8.1％, 8.8％ and 7.3％, respectively. The isolated carbapenem-resistant Klebsiella pneumoniae was mainly distributed in the central intensive care unit, emergency medical ward and neurosurgery. The resistance rate of Klebsiella pneumoniae to carbapenem antibiotics was positively correlated with the ratio of DDDs of carbapenem antibiotics to total DDDs of antibiotics. CONCLUSIONS: The DDDs of carbapenem antibiotics have a great influence on the resistance rate of Klebsiella pneumoniae, and it is necessary to strengthen the monitoring of its clinical application.