2009-2014年我院抗菌药物临床应用对鲍曼不动杆菌耐药性变迁的影响

目的 研究鲍曼不动杆菌耐药性变迁趋势,探讨抗菌药物使用对鲍曼不动杆菌耐药率变化的影响,为临床合理使用抗菌药物提供理论依据.方法 回顾性分析2009-2014年鲍曼不动杆菌耐药率变化趋势及抗菌药物年用量,计算用药频度(DDDs),采用Pearson相关分析法对耐药率与DDDs进行分析.结果 2 859株鲍曼不动杆菌菌株对常用抗菌药物呈多重耐药趋势,对β-内酰胺类、大多β-内酰胺类加酶抑制剂、氨基糖苷类、喹诺酮类、碳青霉烯类、磺胺类的耐药率均超过65.0％,仅对头孢哌酮/舒巴坦和米诺环素的耐药率相对较低,波动在32.1％ ～ 54.2％之间.2009-2014年不同抗菌药物的DDDs有不同程度升降.庆大霉素、头孢吡肟、左氧氟沙星和亚胺培南的DDDs与鲍曼不动杆菌耐药率呈高度正相关(r＞0.800,P＜0.05).结论 鲍曼不动杆菌对常用抗菌药物耐药性较为严重,抗菌药物用量与鲍曼不动杆菌耐药率之间存在一定相关性,应加强抗菌药物临床应用管理.

Influence of clinical use of antibiotics on drug resistance of acinetobacter baumannii at our hospital from 2009 to 2014

Objective To explore the influence of the clinical use of antibiotics on the drug resistance of acinetobacter baumannii and to provide a theoretical basis for the rational use of antimicrobial drugs.Methods The annual consumption of antimicrobial agents and the change trend of drug resistance of acinetobacter baumannii in our hospital from 2009 to 2014 were retrospectively analyzed.And the DDDs of antibiotics were calculated.The correlation between the drug resistance of A.baumannii and the DDDs of antibiotics were analyzed by Pearson analysis.Results 2 859 strains of A.baumannii had a trend of multidrug resistance to common antimicrobial agents.The resistance rate of most beta lactam,enzyme inhibitors,aminoglycosides,quinolones,carbapenems,and sulfonamides were over 65.0％.The resistance rate of cefoperazone/sulbactam and minocycline were relatively low,fluctuating between 32.1％ and 54.2％.The DDDs of different antimicrobial drugs had different degrees of rises and falls from 2009 to 2014.There was a high positive correlation between the resistance rates of A.baumannii and the DDDs of gentamicin,cefepime,levofloxacin,and imipenem (r＞0.800,P＜0.05).Conclusions The resistance of acinetobacter baumannii to commonly used antibacterials is relatively serious.The drug resistance of A.baumannii associates with the consumption of antibiotics;and the integrated management of antimicrobial applications should be strengthened.