肺炎克雷伯菌耐药与抗菌药物使用强度现况及其关联分析

陈菲; 王璐; 王静

doi:10.13898/j.cnki.issn.1000-2200.2019.08.032

肺炎克雷伯菌耐药与抗菌药物使用强度现况及其关联分析

Drug resistance to Klebsiella pneumoniae and use density of antibacterial agents, and their correlation analysis

摘要

摘要:
目的分析肺炎克雷伯菌（KPN）耐药性，抗菌药物使用情况及它们之间的关联，为临床用药提供建议。
方法采用回顾性调查方法，选取2017-2018年住院病人分离到的KPN，统计分析KPN检出率、耐药率，住院病人抗菌药物使用强度（AUD），用Spearman相关法分析AUD与耐药率之间的关系。
结果2018年1季度产超广谱β-内酰胺酶（ESBLs）的KPN检出率低于2017年同期（P < 0.05）；2018年1季度、4季度、全年耐碳青霉烯类药物KPN（CRKP）检出率高于2017年同期（P < 0.05~P < 0.01）。2018年KPN对头孢唑林的耐药率较2017年下降（P < 0.01）；2018年KPN对氨苄西林、氨苄西林/舒巴坦、头孢他啶、头孢曲松、头孢替坦、头孢吡肟、庆大霉素、阿米卡星、环丙沙星、复方新诺明、妥布霉素、亚胺培南、哌拉西林/他唑巴坦的耐药率与2017年相比均有上升（P < 0.05~P < 0.01）；KPN对厄他培南耐药率由2017年0%上升至2018年17.9%（P < 0.01）。AUD数值较高的抗菌药物有头孢硫脒、头孢呋辛钠、哌拉西林他唑巴坦、头孢西丁、左氧氟沙星。2018年第一代、第二代头孢菌素，含β-内酰胺酶抑制剂的复方制剂及碳青霉烯类药物的AUD较2017年均有下降，尤其以头孢呋辛钠和头孢替安下降明显。第二代头孢菌素的AUD与KPN对头孢唑啉耐药率呈正相关关系，与氨苄西林、头孢替坦、厄他培南耐药率呈负相关关系（P < 0.05~P < 0.01）；头孢曲松钠的AUD与KPN对头孢替坦耐药率呈正相关关系（P < 0.05）；头孢哌酮舒巴坦钠的AUD与KPN对氨苄西林、头孢替坦、厄他培南、阿米卡星耐药率呈正相关关系（P < 0.05~P < 0.01），与头孢唑啉呈负相关关系（P < 0.05）；碳青霉烯类药物的AUD与KPN对氨苄西林舒巴坦及复方新诺明的耐药率呈负相关关系（P < 0.05）。
结论KPN耐药情况日渐严重，CRKP检出率升高，KPN耐药率与抗菌药物使用强度存在一定相关性，需合理使用抗菌药物，遏制耐药性的产生。

Abstract:
ObjectiveTo analyze the drug resistance of Klebsiella pneumoniae(KPN) and use density of antibacterial agents, and their correlation, and provide recommendation for clinical use of antibacterial drugs.
MethodsThe detection rate and drug resistance of KPN, and antibiotics use density(AUD) in the inpatients from 2017 to 2018 were retrospectively analyzed, and the correlation of AUD with drug resistance rate was investigated using Spearman correlation analysis.
ResultsThe detection rate of KPN of producing extended-spectrum β-lactamases(ESBLs) in the first quarter of 2018 was lower than that in the same period of 2017(P < 0.05).The detection rates of carbapenem-resistant KPN(CRKP) of producing ESBLs in the first and fourth quarter, and full year of 2018 were higher than that in the same period of 2017(P < 0.05 to P < 0.01).The drug resistance rate of KPN to cefazolin in 2018 decreased compared with that in 2017(P < 0.01).In 2018, the drug resistance rates of KPN to ampicillin, ampicillin/sulbactam, ceftazidime, ceftriaxone, cefotetan, cefepime, gentamicin, amikacin, ciprofloxacin, SMZ-TMP, tobramycin, imipenem and piperacillin/tazobactam were significantly higher than those in 2017(P < 0.05 to P < 0.01).The drug resistance rate of KPN to erapenem increased from 0% in 2017 to 17.9% in 2018(P < 0.01).The antibiotics with high AUD value included ceftiamidine, cefuroxime sodium, piperacillin tazobartan, cefoxitin and levofloxacin.In 2018, the AUD of the first and second generation cephalosporins, compound preparations containing β-lactamase inhibitors and carbapenes decreased compared with that in 2017, especially the decline of cefuroxime sodium and cefotiam was obvious.The AUD of the second generation cephalosporin was positively correlated with the drug resistance rate of KPN to cefazolin, and negatively correlated with the drug resistance rate of ampicillin, cefotetan and ertapenem(P < 0.05 to P < 0.01).The AUD of ceftriaxone sodium was positively correlated with the drug resistance rate of KPN to ceftetan(P < 0.05), the AUD of ceftriaxone sulbactam sodium was positively correlated with the drug resistance rate of KPN to ampicillin, ceftetan, ertapenem and amikacin(P < 0.05 to P < 0.01), and negatively correlated with cefazolin(P < 0.05).The AUD of carbapenems was negatively correlated with the drug resistance rate of KPN to ampicillin sulbactam and trimoxazole(P < 0.05).
ConclusionsThe drug resistance of KPN is becoming more and more serious, and the detection rate of CRKP is increasing.There is a certain correlation between drug resistance rate of KPN and AUD.It is necessary to use antibiotics reasonably and curb the occurrence of drug resistance.

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