摘要
目的探索ICU细菌耐药性与抗菌药物使用强度(AUD)的相关性,为临床合理使用抗菌药物提供理论依据。方法回顾性分析ICU 2009年1月-2010年6月入院患者(对照组)的病原菌构成、耐药率与AUD的相关性,前瞻性干预ICU 2010年7月-2011年12月入院的患者(干预组)的抗菌药物使用,通过监测细菌耐药性的变化,规范抗菌药物临床应用行为,比较两组优势菌株对常用抗菌药物的耐药率与AUD的相关性。结果对照组分离病原菌201株,干预组196株,两组以革兰阴性菌占绝对优势,对照组67.6%、干预组76.0%,差异无统计学意义;两组比较,干预组鲍氏不动杆菌、嗜麦芽寡养单胞菌分别占15.3%、11.7%,较对照组的20.9%、14.9%呈明显下降;干预组肠杆菌科菌和非发酵菌对氟喹诺酮类的耐药率≤30.0%,较对照组>40.0%有显著下降;两组筛选出9种优势菌株的耐药率大多与AUD呈正相关关系,对照组有鲍氏不动杆菌(P<0.01)、溶血葡萄球菌(P<0.05)两组呈显著正相关;干预组有鲍氏不动杆菌、嗜麦芽寡养单胞菌、肺炎克雷伯菌、溶血葡萄球菌、金黄色葡萄球菌5组呈显著正相关(P<0.05),干预组较对照组有显著提高。结论细菌耐药性与AUD有关,降低AUD,能有效扼制细菌耐性的增长,是控制细菌耐药切实可行的监测指标。
OBJECTIVE To explore the correlation between bacterial resistance and antibiotic use density （AUD） in ICU so as to provide evidence for the rational use of antibiotics. METHODS The patients who enrolled the hospital from Jan 2009 to Jun 2010 were assigned to the control group, the constituent ratios of pathogens and the correlation between the hacterial resistance and the AUD were retrospectively analyzed, the prospective intervention was performed for the use of antibiotics by the patients who enrolled the hospital from Jul 2010 to Dec 2011 （the intervention group）, and the correlation between the drug resistance of the predominant strains to common antibiotics and the AUD was compared through the monitoring of change of bacterial resistance and the standardized use of antibiotics. RESULTS There were 201 strains of pathogenic bacteria isolated in control group and 196 strains in the intervention group, among which the gram-negative bacteria were dominant, accounting for 67.6 % in the control group and 76.0 % in the intervention group, the difference was not statistically significant. Acinetobacter baumannii strains accounted for 15.3 % in the intervention group and 20.9% in the control group, and Stenotrophomonas maltophilia strains accounted for 11. 7% in the intervention group and 14. 9% in the control group, presenting a significantly upward trend. The drug resistance rates of Enterobacteriaceae and non- fermenting bacteria to quinolones were no more than 30.0% in the intervention group, significantly decreased as compared with the drug resistance rate more than 40.00% of the control group. The drug resistance rates of the nine species of predominant strains screened in the two groups were positively correlated with AUD, Acinetobacter baumannii stralns（P〈0.01） and Staphylococcus haemolyticus strains （P〈0.05）were both positively correlated in the control group, and A. baumannii, S. maltophilia, Klebsiella pneumonia, S. haemolyticus, and Staphylococcus aureus were positively correlated in the intervention group （P〈0.05） ,the drug resistance rates ofthe intervention group was significantly higher than that of the control group. CONCLUSION It is concluded that the bacterial resistance is related to the AUD. The reduction of AUD can effectively restrain the increase of bacterial resistance, the AUD is a feasible indicator for the monitoring of the bacterial resistance.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2013年第10期2442-2444,共3页
Chinese Journal of Nosocomiology
基金
浙江省药学会医院药学科研基金(2008ZYY02)
关键词
细菌
耐药性
抗菌药物
使用强度
相关性
Bacteria
Drug resistance
Antibiotics
Antibiotic use density
Correlation
