肺炎克雷伯菌耐药率变迁与抗菌药物使用强度的相关性分析

目的：探讨医院肺炎克雷伯菌耐药率与常用抗菌药物使用强度（antibacterial use density，AUD）的相关性，为临床合理使用抗菌药物治疗肺炎克雷伯菌感染提供参考依据。方法：统计收集2012-2017年度医院住院病区常用抗菌药物AUD，监测肺炎克雷伯菌的临床分布和对常见抗菌药物耐药率的变化趋势，采用Pearson相关方法分析其耐药率与抗菌药物AUD的相关性。结果：2012-2017年肺炎克雷伯菌对亚胺培南和美罗培南等多种抗菌药物的耐药率呈现明显变化趋势（P<0.01），其中对哌拉西林他唑巴坦、头孢西丁、亚胺培南、美罗培南、阿米卡星的耐药率均小于30%，但对哌拉西林、氨苄西林舒巴坦、头孢唑林、复方磺胺甲噁唑的耐药率均大于50%。肺炎克雷伯菌对哌拉西林耐药率与头孢他啶AUD呈显著正相关（P<0.01）；对头孢吡肟耐药率与头孢呋辛AUD呈负相关（P<0.05）；对亚胺培南耐药率与阿莫西林克拉维酸钾AUD呈正相关（P<0.05），与头孢唑林AUD和环丙沙星AUD呈负相关（P<0.05）；对环丙沙星耐药率与庆大霉素AUD呈负相关（P<0.05）；对庆大霉素、妥布霉素和复方磺胺甲噁唑耐药率与哌拉西林AUD均呈正相关（P<0.05）。结论：哌拉西林他唑巴坦、头孢西丁、亚胺培南、美罗培南和阿米卡星仍然可以作为临床经验治疗肺炎克雷伯菌感染的首选用药，哌拉西林、氨苄西林舒巴坦、头孢唑林和复方磺胺甲噁唑则需要参照药敏试验结果进行选药。肺炎克雷伯菌耐药率变化与抗菌药物AUD密切相关，临床需要加强对抗菌药物合理使用的管控，以降低抗菌药物使用强度，以减少细菌耐药性的产生。

Correlation between antimicrobial resistant rate of Klebsiella pneumoniae and antimicrobial use density

OBJECTIVE To analyze the correlation between drug resistance rate of Klebsiella pneumoniae and antimicrobial use density (AUD), so as to provide references for the rational use of antibacterial drugs in the treatment of Klebsiella pneumoniae infection. METHODS The antibiotics use density from 2012 to 2017 were collected and retrospectively analyzed. The trend of clinical distribution and drug resistance rate of Klebsiella pneumoniae were constantly monitored, and the correlation between resistant the rate of Klebsiella pneumoniae and antimicrobial use density was conducted by Pearson correlation method. RESULTS The drug resistance rates of Klebsiella pneumoniae to imipenem and meropenem showed a significant trend from 2012 to 2017 (P<0.01).The resistance rates of Klebsiella pneumoniae to piperacillin-tazobactam, cefoxitin, imipenem, meropenem and amikacin were less than 30%, but the resistance rates to piperacillin, ampicillin-sulbactam, cefazolin and compound sulfamethoxazole were more than 50%. The resistance rate of Klebsiella pneumoniae to piperacillin was significantly positively correlated with the AUD of ceftazidime (P<0.01), and the resistance rate to cefepime was negatively correlated with the AUD of cefuroxime (P<0.05). The resistance rate to imipenem was positively correlated with the AUD of amoxicillin/clavulanic(P<0.05) but negatively correlated with the AUD of cefazolin and ciprofloxacin (P<0.05). The resistant rate to ciprofloxacin was negatively correlated with the AUD of gentamicin (P<0.05). A significant positive correlation was found between the resistance rate of Klebsiella pneumoniae to gentamicin, tobramycin and sulfamethoxazole and the AUD of piperacillin (P<0.05). CONLUSION Piperacillin, ceficidin, imipenem, meropenem and amikacin can still be used as the first choice for Klebsiella pneumoniae infection in clinical experience. Piperacillin, ampicillin and sulbactam, cefazolin and trimethoprim-sulfamethoxazole should be selected according to the results of drug susceptibility test. The change of drug resistance rate of Klebsiella pneumoniae is closely related to the antimicrobial AUD. It is necessary to strengthen the control of rational use of antimicrobial agents in clinical practice to reduce the intensity of antimicrobial use and the occurrence of bacterial resistance.