Dou Y, Zhang Q
Burn and Plastic Surgery Department, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China.
Zhonghua Yi Xue Za Zhi. 2020 May 12;100(18):1401-1408. doi: 10.3760/cma.j.cn112137-20191207-02673.
To investigate the effect of antibiotics on bacterial resistance through analyzing the use of common antibiotics and the bacterial prevalence in single-center burn ward. The epidemiological data of pathogenic bacteria and the use of common antibiotics in burn ward of Ruijin Hospital Affiliated to Shanghai Jiaotong University Medical College was investigated in the past 9 years. Bacteria samples were collected from the wounds, catheters, blood, feces, urine and sputum of inpatients in the unit from January 2010 to December 2018. The antibiotics use density was calculated by defined daily doses (DDDs)/(1 000 patient-days). (1) In the proportion of bacteria detected, Staphylococcus aureus was the first and sensitive to glycopeptide antibiotics. Klebsiella pneumonia (19.8%), Pseudomonas aeruginosa (11.9%) and Acinetobacter baumannii (11.5%) were the top three Gram-negative bacteria in 2018; the proportion of Klebsiella pneumoniae was significantly increased ((2)=0.861, 0.001). (2) The Pseudomonas aeruginosa resistance rate to ceftazidime ((2)=0.447, 0.049) and ciprofloxacin ((2)=0.663, 0.008) increased significantly. The Klebsiella pneumoniae resistance rate to piperacillin ((2)=0.999, 0.018), meropenem ((2)=0.999, 0.023), ciprofloxacin ((2)=1.000, 0.010) increased significantly. There was no significant trend in the Acinetobacter baumannii resistance rate. (3) The use density of meropenem increased significantly ((2)=0.492, 0.035), and that of ciprofloxacin decreased significantly ((2)=0.572, 0.018). (4) Carbapenems use density was positively correlated with resistance rate of Klebsiella pneumoniae to cefoperazone sulbactam (0.733, 0.025), piperacillin tazobactam (0.684, 0.042), cefuroxime (0.821, 0.023), ceftazidime (0.741, 0.022), imipenem (0.718, 0.029), meropenem (0.690, 0.040), amikacin (0.750, 0.020). (5) Ciprofloxacin use density was negatively correlated with the Pseudomonas aeruginosa resistance rate to ceftazidime (-0.751, 0.020), Ciprofloxacin (-0.873, 0.002) and with the Klebsiella pneumoniae resistance rate to cefuroxime (-0.767, 0.044), ceftazidime (-0.712, 0.031), imipenem (-0.780, 0.013), meropenem (-0.793, 0.011), ciprofloxacin (-0.871, 0.002), Sulfamethoxazole/trimethoprim (-0.793, 0.011). Carbapenems can induce Klebsiella pneumoniae to be multiple drug resistance; through the relationship between ciprofloxacin use intensity and drug resistance, the strategy of only restricting a certain antimicrobial agent may not restore the bacterial sensitivity.
通过分析单中心烧伤病房常用抗生素的使用情况和细菌流行情况，探讨抗生素对细菌耐药性的影响。回顾性调查上海交通大学医学院附属瑞金医院烧伤病房近9年病原菌的流行病学资料及常用抗生素的使用情况。收集2010年1月至2018年12月该科室住院患者伤口、导管、血液、粪便、尿液和痰液的细菌样本。采用限定日剂量（DDDs）/（1000患者日）计算抗生素使用密度。（1）在检出细菌比例中，金黄色葡萄球菌居首位，对糖肽类抗生素敏感。肺炎克雷伯菌（19.8%）、铜绿假单胞菌（11.9%）和鲍曼不动杆菌（11.5%）是2018年排名前三的革兰阴性菌；肺炎克雷伯菌比例显著上升（χ²=0.861，P=0.001）。（2）铜绿假单胞菌对头孢他啶（χ²=0.447，P=0.049）和环丙沙星（χ²=0.663，P=0.008）的耐药率显著上升。肺炎克雷伯菌对哌拉西林（χ²=0.999，P=0.018）、美罗培南（χ²=0.999，P=0.023）、环丙沙星（χ²=1.000，P=0.010）的耐药率显著上升。鲍曼不动杆菌耐药率无明显变化趋势。（3）美罗培南使用密度显著上升（χ²=0.492，P=0.035），环丙沙星使用密度显著下降（χ²=0.572，P=0.018）。（4）碳青霉烯类抗生素使用密度与肺炎克雷伯菌对头孢哌酮舒巴坦（r=0.733，P=0.025）、哌拉西林他唑巴坦（r=0.684，P=0.042）、头孢呋辛（r=0.821，P=0.023）、头孢他啶（r=0.741，P=0.022）、亚胺培南（r=0.718，P=0.029）、美罗培南（r=0.690，P=0.040）、阿米卡星（r=0.750，P=0.020）的耐药率呈正相关。（5）环丙沙星使用密度与铜绿假单胞菌对头孢他啶（r=-0.751，P=0.020）、环丙沙星（r=-0.873，P=0.002）的耐药率及肺炎克雷伯菌对头孢呋辛（r=-0.767，P=0.044）、头孢他啶（r=-0.712，P=0.031）、亚胺培南（r=-0.780，P=0.013）、美罗培南（r=-0.793，P=0.011）、环丙沙星（r=-0.871，P=0.002）、复方磺胺甲恶唑（r=-0.793，P=0.011）的耐药率呈负相关。碳青霉烯类抗生素可诱导肺炎克雷伯菌多重耐药；通过环丙沙星使用强度与耐药性的关系可知，仅限制某一种抗菌药物的策略可能无法恢复细菌的敏感性。
