描述细菌耐药性变化的新指标

The new indexes of change in bacterial antimicrobial resistance

摘要:

目的了解细菌的耐药状态，探讨能够反映耐药水平、耐药趋势、耐药程度和耐药速率的综合指标。方法分析某院2002—2009年2 884例医院感染患者送检标本分离的1 523株病原菌药敏试验结果，应用阶段耐药率及其率差值、率差比值、率差合值描述常见细菌对抗菌药物的耐药状态变化。结果大肠埃希菌对哌拉西林/他唑巴坦、铜绿假单胞菌对头孢他啶和哌拉西林、肺炎克雷伯菌对阿莫西林/克拉维酸、阴沟肠杆菌对环丙沙星的耐药速率增加最快，其差值分别为8.43、6.87和6.80、31.36、5.65；肺炎克雷伯菌总体耐药程度的增加大于大肠埃希菌，其率差合值分别为136.53、115.65；阴沟肠杆菌的耐药下降程度大于铜绿假单胞菌，其率差合值分别为-125.16、-6.15；金黄色葡萄球菌对抗菌药物的耐药率整体呈增加趋势，表皮葡萄球菌整体呈下降趋势，其率差合值分别为50.30、-157.01。结论阶段耐药率及其率差值、率差比值、率差合值4项指标可从多角度描述细菌的耐药状态，对指导细菌耐药性研究和临床抗菌药物应用具有指导意义。

Abstract:

ObjectiveTo survey bacterial antimicrobial resistance status and evaluate the general indexes which can  evaluate the level, trend, degree and rate of antimicrobial resistance. MethodsAntimicrobial sensitivity test results  of 1 523 strains of pathogens isolated from 2 884 patients with nosocomial infection  in a hospital from 2002 through 2009 were analyzed, and change in common bacterial resistance  to antimicrobial agents was described with  antimicrobial resistant rate of stages, rate difference, ratio and sum of the rate difference . ResultsThe increase of antimicrobial resistant rate was the fastest in  Escherichia coli to piperacillin/tazobactam , Pseudomonas aeruginosa to ceftazidime and piperacillin, Klebsiella pneumoniae to amoxicillin/clavulanic acid, and Enterobacter cloacae to ciprofloxacin, the difference  value was 8.43,6.87,  6.80 ,31.36 and 5.65,  respectively; increase of total antimicrobial resistant rate of  Klebsiella pneumoniae exceeded Escherichia coli, sum of the rate difference was 136.53 and 115.65 respectively; and decrease of  total antimicrobial resistant rate of Enterobacter cloacae exceeded Pseudomonas aeruginosa,  sum of the rate difference was -125.16 and -6.15 respectively; total antimicrobial resistant rate of Staphylococcus aureus showed  a trend of  increase, and Staphylococcus epidermidis showed  a trend of decrease, sum of the rate difference was 50.30 and -157.01, respectively.ConclusionFour indexes including antimicrobial resistant rate of stages, rate difference, ratio and sum of the rate difference can evaluate the antimicrobial resistance from many aspects , which  has important guidance for the  study of antimicrobial resistance and antimicrobial application in clinic.