本院2008-2012年ICU病原菌分布特点及耐药率与哌拉西林/他唑巴坦使用强度相关性分析

目的：回顾2008—2012年本院ICU患者病原菌分布和耐药性的变化趋势，分析哌拉西林／他唑巴坦使用强度与病原菌耐药率的相关性。方法：从检验科和信息中心分别统计2008—2012年病原菌检测、药敏实验结果和哌拉西林／他唑巴坦使用强度，并采用SPSS分析两者的相关性。结果：2008—2012年ICU分离病原菌株数逐年增加，其中革兰阴性菌和革兰阳性菌所占的比例变化不大；肠杆菌科，主要包括大肠埃希菌、肺炎克雷伯菌，分离率逐年增加；非发酵菌、金黄色葡萄球菌的分离率处下降趋势，但非发酵菌仍占最大比例。2008—2012年耐苯唑西林金黄色葡萄球菌的耐药率分别是96．2％、82．5％、79．6％、74．7％和78．1％，呈下降趋势。尚无耐万古霉素、利奈唑胺的金黄色葡萄球菌。哌拉西林／他唑巴坦的使用强度与鲍曼不动杆菌、肺炎克雷伯菌、大肠埃希菌的耐药率有相关性（P〈0．05）。结论：细菌的高耐药率和抗菌药物高使用强度情况比较严重，必须注意监测，需要控制抗菌药物的使用并继续密切监测ICU病原菌耐药变化趋势。

Epidemiology and analysis on the correlation between resistance of pathogenic bacteria and the intensity of piperacillin-tazobactam apllication in intensive care unit from 2008 to 2012

AIM： To investigate the distribution and the correlation between the intensity of piperacillin-tazobactam application and drug resistance of clinical isolates from intensive care unit in hospital from 2008 to 2012. METHODS： Epidemiology, drug resistance and the intensity of piperacillin-tazobactam were studied from clinical laboratory and information centre retrospectively, and the correlation of drug resistance and the intensity of piperacillin-tazobactam was analyzed using SPSS software. RESULTS： The number of isolates was increased every year form 2008 to 2012. The proportion Gram-negative bacteria and Gram-positive bacteria had not changed significantly during the 5 years. Nonfermenting bacteria still accounted for the largest proportion. The proportion of Escherichia coli and Klebsiella pneumoniae had increased respectively, while the proportion of Acinetobacter baumannii and Staphylococcus aureus had de-creased oppositely. The drug resistance rates of MASR were 96.2%, 82.5%, 79.6%, 74.7 and 78.1% respectively , trending downward, from 2008 to 2012, and Staphylococcus aureus resisting to vancomycin and linezolid had not isolated. The resistance rate of Escherichia coli , Klebsiella pneumonia and Acinetobacter baumannii was related with the application density of piperacillin-tazohactam（P〈0.05）. CONCLUSION： The situation of bacterial high resistance and the high density of antimicrobial drug application is serious, and we should keep continuously close surveillance foe the changes of bacterial resistance in ICU and control the use of antibiotics.