鲍曼不动杆菌耐药率与抗菌药物使用相关性分析
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摘要
目的为了解鲍曼不动杆菌耐药率与抗菌药物使用之间的关系,为指导临床合理用药提供依据。方法回顾性调查我院2011-2017年住院患者送检标本中分离的鲍曼不动杆菌的耐药率及同期不同种类抗菌药物的使用情况,通过简单相关与偏相关分析二者之间的关系。结果 2011-2017年我院鲍曼不动杆菌对13种抗菌药物的耐药率总体上呈现上升趋势(P<0.05)。简单相关结果显示,鲍曼不动杆菌对亚胺培南/西司他丁、头孢哌酮/舒巴坦、头孢吡肟、左氧氟沙星和阿米卡星的耐药率与碳青霉烯类的使用量呈高度正相关,相关系数分别为0.814、0.977、0.872、0.966、0.893(P<0.05);鲍曼不动杆菌对美罗培南的耐药率与头孢菌素类、喹诺酮类和氨基糖苷类的使用量呈高度负相关,相关系数分别为-0.889、-0.964、-0.857(P<0.05)。偏相关结果显示,鲍曼不动杆菌对常用7种抗菌药物的耐药率与不同种类抗菌药物的使用量均无相关性(P>0.05)。结论我院鲍曼不动杆菌耐药情况严重,细菌耐药性的升高可能与抗菌药物的不合理使用有关,控制细菌耐药还需加强抗菌药物的规范化管理。
Objective To understand the relationship between the resistance rate of Acinetobacter baumannii and the consumption of antibiotics, and to provide evidences for guiding clinical rational application of drugs. Methods The drug resistance rate of Acinetobacter baumannii isolated from the inpatients and the application of different types of antibiotics were retrospectively investigated during the same period from 2011 to 2017, the relationship was analyzed by bivariate correlation and partial correlation.Results The resistance rate of Acinetobacter baumannii in 13 antibiotics showed an overall upward trend in our hospital from 2011 to 2017,(P<0.05).The results of bivariate correlation showed that the resistance rate of Acinetobacter baumannii in imipenem/cilastatin, cefoperazone/sulbactam, cefepime, levofloxacin and amikacin was highly positive correlated with the application of carbapenems, and the correlation coefficients were 0.814, 0.977, 0.872, 0.966, and 0.893,(P<0.05). The resistance rate of Acinetobacter baumannii was highly negative correlated in meropenem with the application of cephalosporins, quinolones and aminoglycosides. The correlation coefficients were-0.889,-0.964,-0.857(P<0.05). The results of partial correlation showed that there was no correlation between the resistance rate of Acinetobacter baumannii in the common antibiotics of seven types and the application of different antibiotics(P>0.05). Conclusion The drug resistance of Acinetobacter baumannii was serious in our hospital.The increasing of bacterial resistance may be related to the irrational application of antibacterial drugs. To control bacterial resistance, it is necessary to strengthen the standardized management of antibacterial drugs.
Objective To understand the relationship between the resistance rate of Acinetobacter baumannii and the consumption of antibiotics, and to provide evidences for guiding clinical rational application of drugs. Methods The drug resistance rate of Acinetobacter baumannii isolated from the inpatients and the application of different types of antibiotics were retrospectively investigated during the same period from 2011 to 2017, the relationship was analyzed by bivariate correlation and partial correlation.Results The resistance rate of Acinetobacter baumannii in 13 antibiotics showed an overall upward trend in our hospital from 2011 to 2017,(P<0.05).The results of bivariate correlation showed that the resistance rate of Acinetobacter baumannii in imipenem/cilastatin, cefoperazone/sulbactam, cefepime, levofloxacin and amikacin was highly positive correlated with the application of carbapenems, and the correlation coefficients were 0.814, 0.977, 0.872, 0.966, and 0.893,(P<0.05). The resistance rate of Acinetobacter baumannii was highly negative correlated in meropenem with the application of cephalosporins, quinolones and aminoglycosides. The correlation coefficients were-0.889,-0.964,-0.857(P<0.05). The results of partial correlation showed that there was no correlation between the resistance rate of Acinetobacter baumannii in the common antibiotics of seven types and the application of different antibiotics(P>0.05). Conclusion The drug resistance of Acinetobacter baumannii was serious in our hospital.The increasing of bacterial resistance may be related to the irrational application of antibacterial drugs. To control bacterial resistance, it is necessary to strengthen the standardized management of antibacterial drugs.
引文
[1]陈佰义,何礼贤,胡必杰,等.中国鲍曼不动杆菌感染诊治与防控专家共识[J].中国医药科学,2012,2(8):3-8.Chen B Y,He L X,Hu B J,et al.Expert opinion on the diagnosis,treatment and prevention of acinetobacter baumannii infection in China[J].China Medicineand Pharmacy,2012,2(8):3-8.
[2]Lashinsky J N,Henig O,Pogue J M,et al.Minocycline for the treatment of multidrug and extensively drug-resistant A.baumannii:A Review[J].Infectious Diseases and Therapy,2017,6(2):199-211.
[3]March G A,Bratos M A.A meta-analysis of in vitro antibiotic synergy against acinetobacter baumannii[J].Journal of Microbiological Methods,2015,119:31-36.
[4]L zureanu V,Poro nicu M,G ndac C,et al.Infection with acinetobacter baumannii in an intensive care unit in the western part of romania[J].BMC Infectious Diseases,2016,16(1):23-28.
[5]Yang Y,Lee Y,Tsai W,et al.Comparison between bacteremia caused by carbapenem resistant Acinetobacter baumannii and acinetobacter nosocomialis[J].BMC infectious diseases,2013,13(1):311.
[6]祝丙华,赵强,张蓉,等.2011-2016年老年病医院鲍氏不动杆菌耐药率与抗菌药物使用强度相关性分析[J].中华医院感染学杂志,2018,28(18):2740-2743.Zhu B H,Zhao Q,Zhang R,et al.Correlation between drug resistance rate of acinetobacter baumannii strains and use intensity of antibiotics in a geriatric hospital from 2011 to2016[J].Chin J Nosocomiol,2018,28(18):2740-2743.
[7]Jin H,Qiu F,Ji H J,et al.Analysis of drug resistance in1,861 strains of Acinetobacter baumannii[J].Biomedical Reports,2016,4(4):463-466.
[8]Rigatto M H,Vieira F J,Antochevis L C,et al.Polymyxin B in combination with antimicrobials lacking In vitro activity versus polymyxin B in monotherapy in critically Ill patients with acinetobacter baumannii or pseudomonas aeruginosa infections[J].Antimicrobial Agents and Chemotherapy,2015,59(10):6575-6580.
[9]Castanheira M,Mendes R E,Jones R N.Update on acinetobacter species:mechanisms of antimicrobial resistance and contemporary in vitro activity of minocycline and other treatment options[J].Clinical Infectious Diseases,2014,59(6):367-373.
[10]胡付品,郭燕,朱德妹,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251.Hu F P,Guo Y,Zhu D M,et al.Antimicrobial resistance profile of clinical isolates in hospitals across China:report from the CHINET Surveillance Program,2017[J].Chin JInfect Chemother,2018,18(3):241-251.
[11]Phu V D,Wertheim H F L,Larsson M,et al.Burden of hospital acquired infections and antimicrobial use in vietnamese adult intensive care units[J].Plos one,2016,11(1):147544.
[12]Zilberberg M D,Kollef M H,Shorr A F.Secular trends in acinetobacter baumannii resistance in respiratory and blood stream specimens in the United States,2003 to 2012:A survey study[J].Journal of Hospital Medicine,2016,11(1):21-26.
[13]Nepka M,Perivolioti E,Kraniotaki E,et al.In vitro bactericidal activity of trimethoprim-sulfamethoxazole alone and in com bination with colistin against carbapenem-resistant acinetobacter baumannii clinical isolates[J].Antimicrobial Agents and Chemotherapy,2016,60(11):6903-6906.
[14]Xiao S Z,Chu H Q,Han L Z,et al.Resistant mechanisms and molecular epidemiology of imipenem-resistant Acinetobacter baumannii[J].Mol Med Rep,2016,14(3):2483-2488.
[15]Salameh M,Abou Daher L M,Chartouny M,et al.Colistin monotherapy v/s colistin combination therapy for treatment of Acinetobacter infections,a systematic review[J].The Journal of Infection in Developing Countries,2018,12(2):23.
[2]Lashinsky J N,Henig O,Pogue J M,et al.Minocycline for the treatment of multidrug and extensively drug-resistant A.baumannii:A Review[J].Infectious Diseases and Therapy,2017,6(2):199-211.
[3]March G A,Bratos M A.A meta-analysis of in vitro antibiotic synergy against acinetobacter baumannii[J].Journal of Microbiological Methods,2015,119:31-36.
[4]L zureanu V,Poro nicu M,G ndac C,et al.Infection with acinetobacter baumannii in an intensive care unit in the western part of romania[J].BMC Infectious Diseases,2016,16(1):23-28.
[5]Yang Y,Lee Y,Tsai W,et al.Comparison between bacteremia caused by carbapenem resistant Acinetobacter baumannii and acinetobacter nosocomialis[J].BMC infectious diseases,2013,13(1):311.
[6]祝丙华,赵强,张蓉,等.2011-2016年老年病医院鲍氏不动杆菌耐药率与抗菌药物使用强度相关性分析[J].中华医院感染学杂志,2018,28(18):2740-2743.Zhu B H,Zhao Q,Zhang R,et al.Correlation between drug resistance rate of acinetobacter baumannii strains and use intensity of antibiotics in a geriatric hospital from 2011 to2016[J].Chin J Nosocomiol,2018,28(18):2740-2743.
[7]Jin H,Qiu F,Ji H J,et al.Analysis of drug resistance in1,861 strains of Acinetobacter baumannii[J].Biomedical Reports,2016,4(4):463-466.
[8]Rigatto M H,Vieira F J,Antochevis L C,et al.Polymyxin B in combination with antimicrobials lacking In vitro activity versus polymyxin B in monotherapy in critically Ill patients with acinetobacter baumannii or pseudomonas aeruginosa infections[J].Antimicrobial Agents and Chemotherapy,2015,59(10):6575-6580.
[9]Castanheira M,Mendes R E,Jones R N.Update on acinetobacter species:mechanisms of antimicrobial resistance and contemporary in vitro activity of minocycline and other treatment options[J].Clinical Infectious Diseases,2014,59(6):367-373.
[10]胡付品,郭燕,朱德妹,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251.Hu F P,Guo Y,Zhu D M,et al.Antimicrobial resistance profile of clinical isolates in hospitals across China:report from the CHINET Surveillance Program,2017[J].Chin JInfect Chemother,2018,18(3):241-251.
[11]Phu V D,Wertheim H F L,Larsson M,et al.Burden of hospital acquired infections and antimicrobial use in vietnamese adult intensive care units[J].Plos one,2016,11(1):147544.
[12]Zilberberg M D,Kollef M H,Shorr A F.Secular trends in acinetobacter baumannii resistance in respiratory and blood stream specimens in the United States,2003 to 2012:A survey study[J].Journal of Hospital Medicine,2016,11(1):21-26.
[13]Nepka M,Perivolioti E,Kraniotaki E,et al.In vitro bactericidal activity of trimethoprim-sulfamethoxazole alone and in com bination with colistin against carbapenem-resistant acinetobacter baumannii clinical isolates[J].Antimicrobial Agents and Chemotherapy,2016,60(11):6903-6906.
[14]Xiao S Z,Chu H Q,Han L Z,et al.Resistant mechanisms and molecular epidemiology of imipenem-resistant Acinetobacter baumannii[J].Mol Med Rep,2016,14(3):2483-2488.
[15]Salameh M,Abou Daher L M,Chartouny M,et al.Colistin monotherapy v/s colistin combination therapy for treatment of Acinetobacter infections,a systematic review[J].The Journal of Infection in Developing Countries,2018,12(2):23.