| 谷彤彤,张航,姜玲海,袁轶群,方忠宏.2016至2020年上海市某三级医院肺炎克雷伯菌耐药率与抗菌药物使用强度相关性分析[J].中国药事,2021,35(10):1199-1206 |
| 2016至2020年上海市某三级医院肺炎克雷伯菌耐药率与抗菌药物使用强度相关性分析 |
| Correlation Analysis of Drug Resistance and the Use Intensity of Antibiotic of Klebsiella Pneumoniae in a Tertiary Hospital of Shanghai from 2016 to 2020 |
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| DOI：10.16153/j.1002-7777.2021.10.017 |
| 中文关键词: 肺炎克雷伯菌 抗菌药物 碳青霉烯类 |
| 英文关键词: Klebsiella Pneumoniae antimicrobial agents carbapenems |
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| 中文摘要: |
| 目的：分析某三级综合性医院肺炎克雷伯菌耐药率与抗菌药物使用强度之间的关系，为临床合理用药提供参考依据。方法：回顾性分析2016年1月至2020年12月住院患者肺炎克雷伯菌耐药率及同期抗菌药物使用强度，使用SPSS 25.0软件进行统计分析，以Pearson进行相关性检验。结果：临床共分离肺炎克雷伯菌3017株，分离率为26.05%(3017/11580)。2016至2018年肺炎克雷伯菌对大部分抗菌药物耐药率始终保持较高水平。从2019年开始，亚胺培南和美罗培南等抗菌药物耐药率呈现下降趋势。在抗菌药物使用强度上，一代、三代头孢菌素，β-内酰胺类抗生素/β-内酰胺酶抑制剂和喹诺酮类抗菌药物使用强度呈逐年上升趋势，碳青霉烯类抗菌药物使用强度呈缓慢下降趋势。肺炎克雷伯菌对头孢唑啉的耐药率与二代头孢AUD呈正相关(P＜0.05)；对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和氨苄西林/舒巴坦的耐药率与三代头孢和β-内酰胺类抗生素/β-内酰胺酶抑制剂AUD呈正相关(P＜0.05)；对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和氨苄西林/舒巴坦的耐药率与碳青霉烯类AUD呈负相关(P＜0.05)；头孢哌酮/舒巴坦的耐药率与喹诺酮类药物AUD呈正相关(P＜0.05)。结论：通过多个部门对抗菌药物的合理使用进行联合管控，抗菌药物耐药率在2016至2018年波动平稳，在2019年后呈下降趋势，院内管理抗菌药物合理使用初见成效，但部分抗菌药物大量使用导致耐药率仍维持较高水平，临床应继续加强抗菌药物的合理使用，做好院内管控。 |
| 英文摘要: |
| Objective: To analyze the relationship between the drug resistance rate of Klebsiella Pneumonia (KP) and the use intensity of antibiotics in a tertiary hospital of Shanghai. Methods: Retrospective analysis of the drugresistance rate and use intensity of antibiotics of KP of hospitalized patients from January, 2016 and December, 2020 was done. Statistical analyses were performed using SPSS 25.0. The correlation analysis was performed using Pearson’s test. Results: A total of 3017 strains of KP were isolated with a isolation rate of 26.05% (3017/11580). From 2016 to 2018, the resistance rate of KP to most antibiotics remained high. However, the resistance rate of imipenem and meropenem showed a decrease after 2019 (P＜0.05). In terms of the use intensity of antibiotics, the use intensity of first-generation and third-generation cephalosporins, β-lactamase antibiotics/ β-lactamase inhibitors and quinolones showed an increasing trend, while the use intensity of carbapenems decreased slowly. The drug resistance rate of KP to cefazolin was positively correlated with the second generation cephalopod (P＜0.05); the drug resistance rates of piperacillin/tazobactam, cefoperazone/sulbactam and ampicillin/ sulbactam were positively correlated with AUD of three generations of cephalosporin and β-lactamase antibiotics/ β-lactamase inhibitors (P＜0.05); the drug resistance rates of piperacillin/tazobactam, cefoperazone/sulbactam and ampicillin/sulbactam were negatively correlated with carbapenem AUD (P＜0.05); the drug resistance rate of cefoperazone/sulbactam was positively correlated with AUD of quinolones (P＜0.05). Conclusion: Through the combined control of the rational use of antibiotics by multiple departments, the antibiotic resistance rate in our hospital fluctuated steadily from 2016 to 2018 and showed a decreasing trend after 2019. Rational management of antibiotics showed a satisfactory clinical effect. The wide use of some antibiotics results in a high drug resistance rate, and clinical rational use of antibiotics should continue to be strengthened to manage nosocomial infection well. |
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