产超广谱β-内酰胺酶大肠埃希菌分离率及抗菌药物消耗量相关性探究.docVIP

产超广谱β-内酰胺酶大肠埃希菌分离率及抗菌药物消耗量相关性探究钟 艺 冯 霞 张春梅 杨俊何 林红燕 摘要目的了解产超广谱β-内酰胺酶大肠埃希菌的分离率与抗菌药物消耗量之间的关系。方法：统计2000～2004年各类抗菌药物的年消耗量及产超广谱β-内酰胺酶（ESBLs）大肠埃希菌的分离率，采用多元线性回归对消耗量与分离率进行分析。结果：5年来含β-内酰胺酶抑制剂复合制剂的消耗量大幅上升；第2～4代头孢菌素处于上升期，以第4代升幅最大。喹诺酮类用量虽有所波动，但总体呈下降趋势。氨基糖苷类、磺胺类、酰胺醇类用量呈萎缩状态。大肠埃希菌产ESBLs阳性率逐年上升。产ESBLs大肠埃希菌的分离率与第3代头孢菌素、磺胺类、氟喹诺酮类、多肽类的消耗量有显著线性依存关系。结论：为防止产ESBLs大肠埃希菌的局部流行，提示临床使用抗菌药物应更具合理性。 关键词：大肠埃希菌 抗菌药物超广谱β-内酰胺酶 消耗量 A Study of Relationships Between Isolation of Extended-spectrum β-lactamases-producing Escherichia coli and Antimicrobial Consumption 【Abstract】 ObjectiveTo study the relationships between isolation of ESBLs-producing Escherichia coli(E.coli) and antimicrobial consumption. Methods: The consumption of diferent kinds of antimicrobial agents that administered to inpatients during 2000-2004 and isolation of ESBLs-producing E.coli were collected retrospectively. The correlation between the isolation and antimicrobial consumption were analyzed using multiple linear regression. Results: The use of compound β-lactamase inhibitors and second- to fourth -generation cephalosporins significantly increased during the study period，in contrast to a decreased consumption for fluoroquinolones, aminoglycosides, sulfonamides and amphenicols. Isolation of ESBLs-producing E.coli appeared increasing tendency. A statistically significant association existed between isolation of ESBLs-producing E.coli and consumption of third-generation cephalosporins, sulfonamides, fluoroquinolones, polypeption. Conclusion: In order to prevent the ESBLs-producing E.coli infection outbreak, it suggested that antibiotics be used rationally. 【Key words】 Escherichia coli, Antimicrobial, Extended-spectrum β-lactamases, Consumption 大肠埃希菌是引起人类感染最常见的肠杆菌科细菌。产超广谱β-内酰胺酶（ESBLs）的大肠埃希菌在近几年明显增多，使得该菌引起的感染治疗变得日益棘手，抗生素治疗效果下降甚至无效，治疗时间延长，治疗费用增加。本调查通过对我院2000～2004年产ESBLs大肠埃希菌分离情况与各类抗菌药物消耗量之间的关系进行分析，为指导临床合理用药，控制耐药菌株的流行提供依据。 1.材料与方法 1.1菌株来源：2000年1月～2004年12月我院临床标本分离的大肠埃希菌。 1.2ESBL检测：ESBL表型检测按美国NCCLS推荐的纸片筛选及确证