厄他培南引入医院后对抗菌药物使用及细菌耐药性的影响  

Impact on use of antibiotics and bacterial drug resistance after introduction of ertapenem to a hospital

作　　者：杨小燕[1] 陈琳[1] 孙一民[2] 许小敏[3] 杨毓芳[4] 顾吉娜[1] 曾呈军[1] 潘丹美 曹红超 钱勤斌 YANG Xiao-yan;CHEN Lin;SUN Yi-min;XU Xiao-min;YANG Yu-fang;GU Ji-na;ZENG Cheng-jun;PAN Dan-mei;CAO Hong-chao;QIAN Qin-bin(Ningbo No.2 Hospital,Ningbo,Zhejiang 315010,China)

机构地区：[1]宁波市第二医院感染科,浙江宁波315010 [2]宁波市第二医院药学部,浙江宁波315010 [3]宁波市第二医院院感管理科,浙江宁波315010 [4]宁波市第二医院病案统计室,浙江宁波315010

出　　处：《中华医院感染学杂志》2023年第6期938-942,共5页Chinese Journal of Nosocomiology

基　　金：浙江省省市共建重点学科(传染病学)基金资助项目(2016-S04);宁波呼吸系统品牌学科基金资助项目(ppxk2018-05)。

摘　　要：目的 分析厄他培南引入医院后对抗菌药物使用及细菌耐药性变化的影响。方法 收集2019年1月1日-2022年2月28日宁波市第二医院全院出院患者临床资料。以2020年1月医院引入厄他培南为节点,2019年1月1日-2019年12月31日为引入前组,2020年1月1日-2022年2月28日为引入后组,分析两组抗菌药物使用强度及细菌耐药性变化。结果 厄他培南引入后组第2类碳青霉烯类抗菌药物使用强度(AUD)较引入前升高(P<0.05),但喹诺酮类、氨基糖苷类、三四代头孢菌素AUD较引入前下降(P<0.05)。总的抗菌药物AUD下降,但无统计学差异。耐碳青霉烯类抗菌药物铜绿假单胞菌(CRPA)检出率、耐三代头孢菌素肠杆菌的检出率、产超广谱β-内酰胺酶(ESBLs)肠杆菌检出率分别较前下降(P<0.05)。耐碳青霉烯类抗菌药物肠杆菌(CRE)检出率、耐碳青霉烯类抗菌药物鲍氏不动杆菌(CRAB)、耐甲氧西林金黄色葡萄球菌(MRSA)检出率无统计学差异。CRPA检出强度、CRE检出强度、CRAB检出强度、产ESBLs肠杆菌检出强度无统计学差异。耐三代头孢菌素肠杆菌检出强度、MRSA检出强度较引入前升高(P<0.05)。结论 厄他培南引入后可以显著减少喹诺酮类药物及三四代头孢菌素的使用,且肠杆菌、铜绿假单胞菌、鲍氏不动杆菌对碳青霉烯类药物的耐药性没有升高。OBJECTIVE To observe the impact on use of antibiotics and bacterial drug resistance after introduction of ertapenem to a hospital. METHODS The clinical data were collected from the patients who were discharged from Ningbo No.2 Hospital between Jan 1, 2019 and Feb 28, 2022. Set the introduction of ertapenem as time node, the patients who were discharged from Jan 1, 2019 to Dec 31, 2019 were assigned as the pre-introduction group, and the patients who were discharged from Jan 1, 2020 to Feb 28, 2022 were assigned as the post-introduction group. The antibiotics use density(AUD) and bacterial drug resistance were observed and compared between the two groups. RESULTS The AUD of the second category of carbapenems of the post-introduction group was higher than that of the pre-introduction group(P<0.05), while the AUDs of quinolones, aminoglycosides, third and fourth generations of cephalosporins of the post-introduction group were lower than those of the pre-introduction group(P<0.05). The total AUD of antibiotics declined, but there was no significant difference. The isolation rates of carbapenem-resistant Pseudomonas aeruginosa, third generation cephalosporins-resistant Enterobacteriaceae and extended-spectrum β-lactamases(ESBLs)-producing Enterobacteriaceae were lower in the post-introduction group than in the pre-introduction group(P<0.05). There were no significant differences in the isolation rates of carbapenem-resistant Enterobacteriaceae(CRE), carbapenem-resistant Acinetobacter baumannii(CRAB) and methicillin-resistant Staphylococcus aureus(MRSA) between the two groups. There were no significant differences in the incidence densities of CRPA, CRE, CRAB and ESBLs-producing Enterobacteriaceae between the two groups. The incidence densities of third generation cephalosporins-resistant Enterobacteriaceae and MRSA of the post-introduction group were higher than those of the post-introduction group(P<0.05). CONCLUSION The usage of quinolones and third, fourth generations of cephalosporins can be significantly reduce

关 键 词：碳青霉烯类药物 厄他培南 耐碳青霉烯类抗菌药物铜绿假单胞菌 耐碳青霉烯类抗菌药物肠杆菌 耐碳青霉烯类抗菌药物鲍氏不动杆菌 耐三代头孢菌素细菌 

分 类 号：R97[医药卫生—药品]