ICU抗菌药物用量与革兰阴性菌耐药的相关性分析

目的 分析我院2013—2018年ICU抗菌药物用量与常见革兰阴性菌耐药率变化的关系，为临床合理使用抗菌药物提供参考。方法 回顾性调查我院ICU病房6年来抗菌药物用量和常见革兰阴性菌的分布情况及耐药率，采用Pearson相关性分析方法分析两者之间的关系。结果 6年来我院ICU病房抗菌药物的总用量逐年上升，碳青霉烯类和β-内酰胺/β-内酰胺酶抑制剂的使用量排在前两位。ICU病房分离的排名前3位的革兰阴性菌为鲍曼不动杆菌、肺炎克雷伯菌和铜绿假单胞菌，2018年3种细菌的耐碳青霉烯菌株分离率分别达到了84.62%、53.54%和66.41%。相关性分析显示碳青霉烯类的用量与鲍曼不动杆菌对替加环素的耐药率(r=0.871, P=0.024)及对左氧氟沙星的耐药率(r=0.900, P=0.015)成正相关，与肺炎克雷伯菌对美罗培南(r=0.852, P=0.031)、头孢吡肟(r=0.817, P=0.047)及左氧氟沙星(r=0.857, P=0.029)的耐药率成正相关。结论 广谱抗菌药物的使用与革兰阴性菌的耐药之间存在复杂的相关性，因此应严格控制并合理使用抗菌药物，以延缓细菌耐药的发展。

Correlations between the consumption of antibiotics and the resistance of Gram-negative bacteria in ICU

Objective To investigate the correlations between the consumption of antibiotics and resistance of Gram-negative bacteria in ICU from 2013 to 2018, and to provide useful information for rational use of antimicrobial agents. Methods The consumption of antimicrobial agents and the distribution and resistant rates of Gram-negative bacilli from 2013 to 2018 in ICU were retrospectively analyzed, and the Pearson correlation analysis method was used to analyze the relationship between them. Results In the past six years, the consumption of antimicrobial agents has been increasing year by year in ICU. The usage of carbapenems and β-lactam/β-lactamase inhibitors ranked the top two. The top three Gram-negative bacteria isolated from ICU wards were Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. In 2018, the isolation rates of carbapenems resistant strains of the three bacteria reached 84.62%, 53.54% and 66.41% respectively. The correlation analysis showed that the use of carbapenems and the resistant rates of Acinetobacter baumannii to tigecycline (r=0.871, P=0.024) and levofloxacin (r=0.900, P=0.015) were positively correlated, and the resistance rates of Klebsiella pneumoniae to meropenem (r=0.852, P=0.031), cefepime (r=0.817, P=0.047), and levofloxacin (r=0.857, P=0.029) were also positively correlated. Conclusion There is a complex correlation between the use of broad-spectrum antibacterial drugs and the drug resistance of Gram-negative bacteria, and thus the clinical application of antimicrobialagents should be strictly and rationally controlled to slow down the development of bacterial resistance.