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目的了解医院碳青霉烯类抗菌药物使用和耐亚胺培南或美罗培南鲍氏不动杆菌(IRAB或MRAB)的耐药趋势及其之间的相关性,为评价和干预临床不合理用药提供依据。方法收集2008年1月-2010年12月江苏省7所三级甲等综合性医院住院患者临床分离鲍氏不动杆菌共14 528株,分别来自患者的痰液、尿液、血液、脓液、腹水等标本,通过SPSS13.0软件,对抗菌药物使用频度(DDDs/1000)、耐药率及耐药趋势进行线性回归、相关系数法、χ2检验分析。结果 2008-2010年每半年南京4所医院检出鲍氏不动杆菌显示增加趋势(P<0.01),徐州3所医院检出鲍氏不动杆菌无变化;2008-2010年南京和徐州地区每半年IRAB和MRAB耐药率均呈显著增加趋势(P<0.05);2008-2010年每半年亚胺培南的DDDs在南京地区呈增长趋势(P<0.05),从5.97上升至8.40;每半年美罗培南的DDDs在南京和徐州地区呈增长趋势,从6.45和1.08上升至12.89和4.15,差异有统计学意义(P<0.01);亚胺培南、美罗培南和总碳青霉烯类DDDs增加趋势与ABA临床分离株数、IRAB和MRAB耐药率增加均显著相关(P<0.05)。结论避免或限制碳青霉烯类抗菌药物使用,有助于减少IRAB和MRAB耐药率及临床分离株。
Objective To understand the drug resistance trends of carbapenem antibiotics and imipenem-resistant or meropenem-resistant Acinetobacter baumannii (IRAB or MRAB) in hospital and the correlation between them, and to evaluate and intervene in clinical irrational drug use Provide evidence. Methods A total of 14 528 clinical isolates of Acinetobacter baumannii were collected from 7 third class general hospitals in Jiangsu Province from January 2008 to December 2010. They were sputum, urine, blood, pus , Ascites and other specimens. Linear regression was performed on the frequency of antimicrobial use (DDDs / 1000), resistance rate and drug resistance trend by SPSS 13.0 software, correlation coefficient method, χ 2 test. Results In 2008-2010, Acinetobacter baumannii was detected in 4 hospitals in Nanjing every half year (P <0.01), while Acinetobacter baumannii was detected in 3 hospitals in Xuzhou from 2008 to 2010. Each year in Nanjing and Xuzhou The resistance rates of IRAB and MRAB in six months showed a significant increase trend (P <0.05). DDDs of imipenem in each half of 2008-2010 increased in Nanjing (P <0.05), from 5.97 to 8.40; every six months Meropenem’s DDDs showed an increasing trend in Nanjing and Xuzhou from 6.45 and 1.08 to 12.89 and 4.15, respectively, with significant difference (P <0.01); DDDs of imipenem, meropenem and total carbapenems were increased The trends were significantly correlated with the number of ABA clinical isolates, IRAB and MRAB resistance (P <0.05). Conclusion Avoiding or limiting the use of carbapenem-based antimicrobials may reduce the rate of IRAB and MRAB resistance and clinical isolates.