2011 年至 2017 年中国一家三级医院的抗生素使用与碳青霉烯类耐药革兰氏阴性菌流行情况的关系。
Antibiotic consumption versus the prevalence of carbapenem-resistant Gram-negative bacteria at a tertiary hospital in China from 2011 to 2017.
机构信息
Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
出版信息
J Infect Public Health. 2019 Mar-Apr;12(2):195-199. doi: 10.1016/j.jiph.2018.10.003. Epub 2018 Oct 29.
PURPOSE
China launched a 3-year rectification scheme on the clinical use of antibiotics in 2011, and a specific scheme on carbapenem use in February 2017. This study investigated the trends in and correlations between antibiotic consumption and the prevalence of carbapenem-resistant Gram-negative bacteria (CRGN) at a tertiary hospital during these years, particularly in carbapenem consumption.
METHODS
The data were collected calculated per quarter from 2011 to 2017. The trends in antibiotic consumption and resistance were analyzed by regression analysis, while Spearman correlation analysis was used to assess the correlations.
RESULT
The total consumption of antibiotics halved during the 7-year study period, from 770.15 DDDs/1000 PDs in quarter 1 of 2011 to 395.07 DDDs/1000 PDs in quarter 4 of 2017. Meantime, carbapenem consumption showed the significant increase, from 28.71 DDDs/1000 PDs to 49.2 DDDs/1000 PDs. The detection rates of CRGN (carbapenem-resistant Klebsiella pneumonia, Acinetobacter baumannii, and Pseudomonas aeruginosa) remained stable (P>0.05). The positive correlation was only discovered between the resistance rate of carbapenem-resistant K. pneumonia and the usage of carbapenems, which included meropenem and imipenem, with coefficients of 0.543, 0.537, and 0.497 (P<0.05), respectively. There was no more significant correlation in this study.
CONCLUSION
The total consumption of antibiotics reduced significantly in the analysed hospital, which could be related to the antimicrobial stewardship programme. However, the carbapenem consumption was increased. The specific index should be established to limit the application of carbapenems. This study identified the positive correlation between the detection rate of carbapenem-resistant K. pneumonia and carbapenem consumption. More research is needed to confirm the impact of restricting and appropriated use of carbapenems on the prevalence of CRGN.
目的
中国于 2011 年启动了为期 3 年的抗生素临床使用整顿计划，并于 2017 年 2 月出台了具体的碳青霉烯类药物使用方案。本研究旨在调查在此期间，一家三级医院抗生素使用量和碳青霉烯类耐药革兰阴性菌（CRGN）流行率的变化趋势及其相关性，尤其是碳青霉烯类药物的使用量。
方法
数据按季度从 2011 年至 2017 年收集计算。采用回归分析方法分析抗生素使用量和耐药性的变化趋势，采用斯皮尔曼相关分析评估相关性。
结果
7 年研究期间，抗生素总消耗量减少了一半，从 2011 年第 1 季度的 770.15 DDDs/1000 PDs 降至 2017 年第 4 季度的 395.07 DDDs/1000 PDs。同时，碳青霉烯类药物的使用量显著增加，从 28.71 DDDs/1000 PDs 增加至 49.2 DDDs/1000 PDs。CRGN（耐碳青霉烯肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌）的检出率保持稳定（P>0.05）。仅发现耐碳青霉烯肺炎克雷伯菌的耐药率与碳青霉烯类药物（包括美罗培南和亚胺培南）的使用之间存在正相关，相关系数分别为 0.543、0.537 和 0.497（P<0.05），但在本研究中未发现其他显著相关性。
结论
分析医院的抗生素总消耗量显著下降，这可能与抗菌药物管理计划有关。然而，碳青霉烯类药物的使用量增加。应建立特定指标来限制碳青霉烯类药物的应用。本研究发现耐碳青霉烯肺炎克雷伯菌的检出率与碳青霉烯类药物的使用之间存在正相关。需要进一步研究来证实限制和合理使用碳青霉烯类药物对 CRGN 流行率的影响。
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