易燕桃,李迪,潘敏,陈影,余燕红
YI Yantao,LI Di,PAN Min,CHEN Ying,YU Yanhong

• 1:肇庆市第二人民医院临床药学科
• 2:肇庆市第二人民医院普儿科

摘要(Abstract)：

目的了解普儿科临床常见病原菌耐药变化趋势及抗菌药物的使用量,探讨两者的相关性。方法统计2010-01~2014-12普儿科9种抗菌药物使用量以及临床分离的大肠埃希菌、肺炎克雷伯菌、产气肠杆菌3种细菌耐药率,计算9种抗菌药物的用药频度(DDDs/100床日),对抗菌药物DDDs与耐药率进行相关性分析。结果 3种细菌对抗菌药物呈现不同程度的耐药水平。哌拉西林/他唑巴坦DDDs与大肠埃希菌对头孢曲松、头孢噻肟耐药率呈正相关(P<0.05),头孢哌酮/舒巴坦DDDs与大肠埃希菌对哌拉西林/他唑巴坦耐药率呈负相关(P<0.05)。阿莫西林/舒巴坦DDDs与肺炎克雷伯菌对哌拉西林/他唑巴坦、头孢他定耐药率呈正相关(P<0.05),替卡西林/克拉维酸钾DDDs与肺炎克雷伯菌对头孢呋辛、头孢曲松、头孢噻肟耐药率呈负相关(P<0.05),头孢呋辛和头孢哌酮/舒巴坦DDDs与肺炎克雷伯菌对头孢他定耐药率呈正相关(P<0.05),亚胺培南DDDs与肺炎克雷伯菌对头孢曲松、头孢噻肟耐药率呈负相关(P<0.05)。头孢他啶DDDs与产气肠杆菌对阿莫西林/舒巴坦、替卡西林/克拉维酸钾、哌拉西林/他唑巴坦耐药率呈负相关(P<0.05)。结论优化专科用药,减轻选药压力,合理应用抗菌药物的同时也不能忽视医院感染的控制。
OBJECTIVE To understand the drug resistance trends of the clinical common pathogens and the usage of antibacterials in pediatrics,so as to explore the correlation of them. METHODS Counting the usage of nine kinds of antibacterials and the drug resistance rate of the three kinds of bacteria,the Escherichia coli( EPEC),Klebsiella pneumoniae and Enterobacter aerogenes which were clinically isolated in pediatrics from January 2010 to December2014,calculating the frequency of drug use of these nine kinds of antibacterials( DDDs / 100 beds day),using statistics to calculate the DDDs and then doing a correlation analysis with the bacterial resistance rate.RESULTS The 3 kinds of bacteria exhibit varying degrees of drug resistance levels to antibacterials. The drug resistance rate of piperacillin / tazobactam DDDs and Escherichia coli( EPEC) to ceftriaxone,cefotaxime was positively correlated( P<0. 05),the drug resistance rate of cefoperazone / sulbactam DDDs and Escherichia coli( EPEC) to piperacillin / tazobactam was negatively correlated( P< 0. 05). The drug resistance rate of Amoxicillin / sulbactam DDDs and Klebsiella pneumoniae to piperacillin /tazobactam,ceftazidime was positively correlated( P < 0. 05),the drug resistance rate of ticarcillin / clavulanate potassium DDDs and Klebsiella pneumoniae to cefuroxime,ceftriaxone,cefotaxime rate was negatively correlated( P < 0. 05),the drug resistance rate of cefuroxime and cefoperazone / sulbactam DDDs and Klebsiella pneumoniae to ceftazidime was positively correlated( P<0.05),the drug resistance rate of imipenem DDDs and Klebsiella pneumoniae to ceftriaxone and cefotaxime was negatively correlated( P < 0. 05). The drug resistance rate of ceftazidime DDDs and Enterobacter aerogenes to amoxicillin / sulbactam,ticarcillin / clavulanate potassium,piperacillin / tazobactam was negatively correlated( P < 0. 05). CONCLUSION The usage of Azithromycin affects the impact of Escherichia coli( EPEC) and Enterobacter aerogenes to other antibacterials,and queries this product to lunch a drug susceptibility test on enterobacteria. When optimizing the specialty drugs,reducing the pressure of drug selection and rational using of antimicrobials we should also can not ignore the control of the hospital infection.

关键词(KeyWords)： 大肠埃希菌;肺炎克雷伯菌;产气肠杆菌;抗菌药物使用量;耐药率;相关性分析
escherichia coli(EPEC);klebsiella pneumoniae;enterobacter aerogenes;usage of antimicrobials;drug resistance rate;correlation analysis

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 易燕桃,李迪,潘敏,陈影,余燕红
YI Yantao,LI Di,PAN Min,CHEN Ying,YU Yanhong

参考文献(References)：

• [1]Nicasio AM,Kuti JL,Nicolau DP.The current state of multidrug-resistant gram-negative bacilli in North Americal[J].Pharmacother,2008,28(2):235-249.
• [2]汪复执笔.2012年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2013,13(5):321-330.
• [3]陈中举执笔.2011年中国CHINET肠杆菌属细菌耐药性监测[J].中国感染与化疗杂志,2013,13(4):248-254.
• [4]Slama TG.Gram-negative antibiotic resistance:there is a price to pay[J].Crit Care,2008,12(Suppl 4):s4.
• [5]Rybak MJ.Pharmacodynamics:relation to antimicrobial resistance[J].Am J Med,2006,119(Suppl 1):S37-S44.
• [6]李淑华,何丽雅,邓力,等.抗菌药物管理初期广州地区儿童肺炎链球菌及流感嗜血杆菌耐药性变迁[J].广东药学院学报,2014,30(6):740-743.
• [7]Iosifidis E,Antachopoulos C,Tsivitanidou M,et al.Differential correlation between rates of antimicrobial drug consumption and prevalence of antimicrobial resistance in a tertiary care hospital in Greece[J].Infect Control Hosp Epidemiol,2008,29(7):615-622.