某院2012-2021年住院病区甲氧西林耐药的金黄色葡萄球菌的检出率与抗菌药物使用强度的相关性分析  

Analysis of Correlation between Detection Rate of Methicillin-resistant Staphylococcus Aureus and Antibiotics Use Density in InpatientWards of a Hospital from 2012 to 2021

作　　者：王广钊[1,2] 莫坚 李杨 蒙光义 冯茵怡[2] 冯紫薇 梁巧琳 黄兴振 WANG Guang-zhao;MO Jian;LI Yang;MENG Guang-yi;FENG Yin-yi;FENG Zi-wei;LIANG Qiao-lin;HUANG Xing-zhen(School of Pharmacy,Guangxi Medical University,Nanning 530000,China;Department of Pharmacy,Yulin First People's Hospital,Yulin Guangxi 537000,China;Department of Intervention,Yulin First People's Hospital,Yulin Guangxi 537000,China)

机构地区：[1]广西医科大学药学院,南宁530000 [2]玉林市第一人民医院药学部,广西玉林537000 [3]玉林市第一人民医院介入科,广西玉林537000

出　　处：《抗感染药学》2024年第10期1018-1024,1043,共8页Anti-infection Pharmacy

基　　金：玉林市科学研究与技术开发计划科技攻关项目(编号:玉市科20204305)。

摘　　要：目的:分析医院2012-2021年住院病区甲氧西林耐药的金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)的检出率与抗菌药物使用强度(antibiotics use density,AUD)的相关性,为临床细菌耐药的防控和抗菌药物的合理使用提供参考。方法:选取2012年1月-2021年12月玉林市第一人民医院病区送检标本的病原学结果和抗菌药物的使用数据作为研究资料,统计革兰阳性菌及其中金黄色葡萄球菌(Staphylococcus aureus,SA)的检出数据和SA对各种抗菌药物的耐药率,计算历年各抗菌药物的AUD,分析MRSA的检出率与AUD的相关性。结果:2012-2021年,医院住院病区革兰阳性菌中SA的检出率从26.70%升至50.70%,变化显著(P<0.01);而SA中MRSA的检出率在38.20%至57.04%之间浮动,平均检出率为48.27%;药敏结果显示,SA对环丙沙星、复方磺胺甲噁唑、红霉素、克林霉素、四环素、庆大霉素的耐药率呈逐年下降之势,并且变化显著(P<0.01),此外SA对万古霉素、利奈唑胺的耐药率始终为0.00%;2012-2021年,青霉素、头孢唑林、红霉素、克林霉素、左氧氟沙星和总喹诺酮类药物的AUD均呈下降趋势(P<0.05),而氨苄西林-舒巴坦钠、哌拉西林-他唑巴坦钠、万古霉素、利奈唑胺、替加环素和莫西沙星的AUD呈升高趋势(P<0.05);相关性分析显示,MRSA的检出率与青霉素、头孢呋辛、红霉素、阿奇霉素、左氧氟沙星、总喹诺酮类的AUD呈正相关(P<0.05),而与氨苄西林-舒巴坦钠、环丙沙星、万古霉素、利奈唑胺、替加环素的AUD呈负相关(P<0.05);线性回归分析结果显示,MRSA的检出率与阿奇霉素、左氧氟沙星、环丙沙星、总喹诺酮类药物的AUD相关性的确定系数R2均大于0.7,具有临床意义。结论:医院MRSA的检出率常年维持在较高水平,而其又与阿奇霉素、左氧氟沙星、环丙沙星、总喹诺酮类药物的使用关系密切,故临床开展抗感染治疗时应适当调整此类高相�Objective:To analyze the correlation between the detection rate of methicillin-resistant Staphylococcus aureus(MRSA)and the antibiotics use density(AUD)in inpatient wards of a hospital from 2012 to 2021,and provide reference for the prevention and control of antimicrobial resistance and the rational use of antibacterial drugs.Methods:The etiological results and antibacterial drug use data of specimens sent from inpatient wards of Yulin First People's Hospital from January 2012 to December 2021 were selected as research data.The detection data of Gram-positive bacteria and Staphylococcus aureus(SA)and the resistance rates of SA to various antibacterial drugs were statistically analyzed,the AUD of each antibacterial drug over the years was calculated,and the correlation between the detection rate of MRSA and the AUD was analyzed.Results:From 2012 to 2021,the detection rates of SA in Gram-positive bacteria in inpatient wards of the hospital increased from 26.70%to 50.70%,with a significant change(P<0.01);the detection rates of MRSA in SA fluctuated between 38.20%and 57.04%,with an average detection rate of 48.27%.The drug susceptibility test results showed that the resistance rates of SA against ciprofloxacin,compound sulfamethoxazole,erythromycin,clindamycin,tetracycline,and gentamicin decreased year by year,with significant changes(P<0.01).In addition,the resistance rates of SA against vancomycin and linezolid were always 0.00%.From 2012 to 2021,the AUDs of penicillin,cefazolin,erythromycin,clindamycin,levofloxacin and total quinolones showed a decreasing trend(P<0.05),while the AUDs of ampicillin-sulbactam sodium,piperacillin-tazobactam sodium,vancomycin,linezolid,tigecycline and moxifloxacin showed an increasing trend(P<0.05).The correlation analysis showed that the detection rate of MRSA was positively correlated with the AUDs of penicillin,cefuroxime,erythromycin,azithromycin,levofloxacin and total quinolones(P<0.05)and negatively correlated with the AUDs of ampicillin-sulbactam sodium,ciprofloxacin,vancomycin

关 键 词：甲氧西林耐药的金黄色葡萄球菌 抗菌药物使用强度 相关性 合理用药 

分 类 号：R915[医药卫生—微生物与生化药学] R378.11[医药卫生—药学]