碳青霉烯耐药G-杆菌分布特征及其与抗菌药物使用强度相关性分析  

Distribution characteristics of carbapenem-resistant organisms and its correlation with the intensity of antibiotic use

作　　者：冀召帅 高远 赵莹鹏 毛乾泰 艾超 JI Zhaoshuai;GAO Yuan;ZHAO Yingpeng;MAO Qiantai;AI Chao(Department of Clinical Pharmacy,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China;Department of Laboratory Medicine,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China;Department of Radiation Oncology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]北京清华长庚医院药学部,北京102218 [2]北京清华长庚医院检验科,北京102218 [3]北京清华长庚医院放射治疗科,北京102218

出　　处：《安徽医药》2023年第4期844-848,共5页Anhui Medical and Pharmaceutical Journal

基　　金：北京市医院管理中心创新梦工场经费资助(202121)。

摘　　要：目的探讨碳青霉烯耐药革兰阴性杆菌(CRO)耐药特征以及与碳青霉烯类抗菌药物使用强度(AUD)之间的相关性。方法统计北京清华长庚医院2016—2020年分离的CRO临床资料以及同期碳青霉烯类药物使用情况,分析两者之间的相关性。结果临床共分离出CRO菌株3342株,其中以碳青霉烯耐药肺炎克雷伯菌(CRKP)1280株(38.30%)、碳青霉烯耐药鲍曼不动杆菌(CRAB)1094株(32.73%)、碳青霉烯耐药铜绿假单胞菌(CRPA)609株(18.22%)、碳青霉烯耐药大肠埃希菌(CREC)136株(4.07%)为主;分布科室主要有重症医学科1423株(42.58%)、普内科406(12.15%)、肝胆胰外科310(9.28%)等;2016—2020年CRO、CRKP、碳青霉烯耐药阴沟肠杆菌检出率均呈逐年上升趋势,其检出率与美罗培南使用强度呈强相关(r=0.90、0.90、1.00);而CRAB、CRPA检出率与美罗培南呈中度相关(r=0.50、0.70);CREC检出率与亚胺培南呈中度相关(r=0.50)。结论CRO尤其是CRKP、碳青霉烯耐药阴沟肠杆菌耐药率仍处于不断上升趋势,且与美罗培南的使用强度呈强相关性,临床应加强此类抗菌药物应用管理,遏制CRO的增长。Objective To investigate the distribution characteristics of Carbapenem-Resistant Organisms(CRO),and the correlation between CRO and the Antibiotics Use Density of carbapenem(AUD).Methods The clinical data of CRO and the use of carbapenems in Beijing Tsinghua Changgung Hospital from 2016 to 2020 were retrospectively collected,then the correlation was statistically analyzed.Results A total of 3342 CRO strains were detected,including 1280 strains of carbapenem resistant Klebsiella Pneumoniae(CRKP)(38.30%),1094 strains of carbapenem resistant Acinetobacter baumannii(CRAB)(32.73%),609 strains of carbapenem resistant Pseudomonas Aeruginosa(CRPA)(18.22%)and 136 strains of carbapenem resistant Escherichia Coli(CREC)(4.07%).As for the department distribution,there were 1423 strains(42.58%)in intensive care,406(12.15%)in general medicine and 310(9.28%)in hepatobiliary and pancreatic surgery..From 2016 to 2020,the detection rates of CRO,CRKP and carbapenem resistant Enterobacter cloacae showed an upward trend year by year,and the detection rates were strongly correlated with the use intensity of meropenem(r=0.90,0.90 and 1.00,respectively),while the detection rates of CRAB and CRPA were moderately correlated with meropenem(r=0.50 and 0.70,respectively);the detection rate of CREC was moderately correlated with imipenem(r=0.50).Conclusions The drug resistance rate of CRO,especially CRKP and carbapenem resistant Enterobacter cloacae,are still rising,and are strongly correlated with the use intensity of meropenem.The clinical application management of antibiotics should be strengthened to curb the growth of CRO.

关 键 词：革兰阴性杆菌 抗药性 多种 细菌 碳青霉烯类 抗菌药物使用强度 相关性分析 

分 类 号：R446.5[医药卫生—诊断学]