抗菌药物使用强度对半年后医院感染金黄色葡萄球菌耐药率的影响

目的探讨抗菌药物使用强度(AUD)对半年后耐甲氧西林金黄色葡萄球菌(MRSA)检出率及医院感染金黄色葡萄球菌(HA-SA)耐药率的影响。方法以半年为单位,统计2012—2015年各类AUD、MRSA检出率和HA-SA对各类抗菌药物的耐药率,采用相关分析和多元线性回归,分析HA-SA对各类抗菌药物的耐药率与同期上半年度各类AUD的相关性。结果 2012年上半年—2015年下半年,总AUD从128.2下降至49.0,除碳青霉烯类AUD上升外,其他类别AUD均下降。2012年下半年—2015年下半年,收治住院患者104 249例,从40 884份病原学标本中分离金黄色葡萄球菌(SA)1 008株,其中社区感染857株(85.02%),医院感染151株(14.98%)。HA-MRSA分离率从2012年下半年的31.25%下降至2015年下半年的12.50%;社区感染耐甲氧西林金黄色葡萄球菌(CA-MRSA)分离率从7.08%上升至16.08%,HA-SA的耐药率普遍高于CA-SA。HA-SA对环丙沙星的耐药率持平,对左氧氟沙星的耐药率上升,对其他8种抗菌药物的耐药率均下降;CA-SA对苯唑西林、环丙沙星、克林霉素、庆大霉素和左氧氟沙星的耐药率上升,对其他药物的耐药率下降;未检出耐万古霉素和利奈唑胺的SA。HA-SA对阿奇霉素和红霉素的耐药率与大环内酯类AUD相关,对克林霉素的耐药率与氨基糖苷类AUD相关,对庆大霉素的耐药率与大环内酯类AUD和总AUD相关。结论抗菌药物选择性压力仍然是细菌产生耐药性的重要原因,降低AUD可减少HA-MRSA检出,降低HA-SA耐药率。

Effect of antimicrobial use density on antimicrobial resistance rate of healthcare associated Staphylococcus aureus half a year later

ObjectiveTo explore the effect of antimicrobial use density (AUD) on the detection rate of methicillin resistant Staphylococcus aureus (MRSA) and antimicrobial resistance rate of healthcare associated Staphylococcus aureus (HA SA) half a year later.MethodsFrom 2012 to 2015, all types of AUD, detection rate of MRSA, and antimicrobial resistance rate of HA SA were calculated semiannually, correlation between antimicrobial resistance rate of HA SA and all types of AUD in the same first half of year were analyzed with correlation analysis and multiple linear regression.ResultsFrom the first half of 2012 to the latter half of 2015, the total AUD declined from 128.2 to 49.0, except the AUD of carbapenems rose, AUD of other antimicrobial agents declined. From the latter half of 2012 to the latter half of 2015, 104 249 patients were admitted to the hospital, and 1 008 strains of SA were isolated from 40 884 specimens, 857 (85.02%) of which were community associated SA(CA SA) and 151 (14.98%) were HA SA. Isolation rate of HA MRSA declined from 31.25% in the latter half of 2012 to 12.50% in the latter half of 2015；isolation rate of CA MRSA rose from 7.08% to 16.08%, resistance rate of HA SA was generally higher than that of CA SA. Antimicrobial resistance rate of HA SA to ciprofloxacin remained the same, to levofloxacin increased, to 8 other antimicrobial agents all declined; resistance rates of CA SA to oxacillin, ciprofloxacin, clindamycin, gentamicin, and levofloxacin increased, but to other antimicrobial agents declined; no SA strains was found to be resistant to vancomycin and linezolid. The resistance rate of HA SA to azithromycin and erythrocin was correlated with the AUD of macrolides, resistance rate of HA SA to clindamycin was correlated with the AUD of aminoglycosides, to gentamicin was correlated with the AUD of macrolides and the total AUD.ConclusionThe selective pressure of antimicrobial agents is still the important cause of the occurrence of antimicrobial resistance, decreasing the AUD of antimicrobial agents will help for reducing the detection rate of HA MRSA and drug resistance rate of HA SA.