CAJ | 학술논문

目的：了解鲍曼不动杆菌耐药性与抗菌药物使用情况的相关性，为临床合理用药、控制感染提供依据。方法回顾性调查上海交通大学医学院附属瑞金医院2006-2010年住院患者抗菌药物的使用情况，计算各类药物的使用强度；同时采用K-B 法检测同期住院患者送检标本中分离的鲍曼不动杆菌对常用抗菌药物的耐药率；应用 SPSS16．0统计软件进行数据分析。结果分离自住院患者的鲍曼不动杆菌对受试抗菌药物耐药率高，仅对阿米卡星、碳青霉烯类及β内酰胺酶抑制剂复方的耐药率相对较低。临床上氟喹诺酮类及头孢菌素类抗菌药物使用强度较高。鲍曼不动杆菌对亚胺培南、美罗培南的耐药率与碳青霉烯类抗生素的使用强度呈正相关（r 均＝0．975，P 均＜0．05）。鲍曼不动杆菌对头孢菌素类、氨基糖苷类、氟喹诺酮类和β内酰胺酶抑制剂复方的耐药率与这些药物的使用强度无相关性（P 均＞0．05）。结论鲍曼不动杆菌耐药现象严重，需引起重视，经验治疗时可选择阿米卡星和β内酰胺酶抑制剂复方类药物，碳青霉烯类抗生素的使用应严格掌握适应证。
목적：료해포만불동간균내약성여항균약물사용정황적상관성，위림상합리용약、공제감염제공의거。방법회고성조사상해교통대학의학원부속서금의원2006-2010년주원환자항균약물적사용정황，계산각류약물적사용강도；동시채용K-B 법검측동기주원환자송검표본중분리적포만불동간균대상용항균약물적내약솔；응용 SPSS16．0통계연건진행수거분석。결과분리자주원환자적포만불동간균대수시항균약물내약솔고，부대아미잡성、탄청매희류급β내선알매억제제복방적내약솔상대교저。림상상불규낙동류급두포균소류항균약물사용강도교고。포만불동간균대아알배남、미라배남적내약솔여탄청매희류항생소적사용강도정정상관（r 균＝0．975，P 균＜0．05）。포만불동간균대두포균소류、안기당감류、불규낙동류화β내선알매억제제복방적내약솔여저사약물적사용강도무상관성（P 균＞0．05）。결론포만불동간균내약현상엄중，수인기중시，경험치료시가선택아미잡성화β내선알매억제제복방류약물，탄청매희류항생소적사용응엄격장악괄응증。
Objective To investigate the relationship between antibiotic use and antimicrobial resistance in Acinetobacter bau-mannii for rational use of antibiotics.Methods Antibiotic use density (AUD)of common antibiotics in hospitalized patients were collected in a tertiary hospital between 2006 and 2010.Clinical isolates of A.baumannii from those patients were collect-ed.The resistance to common antimicrobial agents were tested by disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI,2012)guidelines.Relationship between antibiotic use and antimicrobial resistance in A.baumannii was analysed by SPSS 16.0.Results The resistant rates of A.baumannii isolated from inpatients were high.Consumption of cephalosporins and quinolones were large.There was a positive correlation between the resistant rate of A.baumannii to imi-penem and AUD of carbapenems (r=0.975,P <0.05).The resistant rate of A.baumannii to meropenem showed significantly positive relation to AUD of carbapenems (r= 0.975,P <0.05).Resistant rates of aminoglycosides,quinolones,cephalospo-rins and beta-lactamase inhibitors was not correlated to AUD of those antibiotics.Conclusions We should pay more attention to the high prevalence of resistant A.baumannnii strains.Application of imipenem and meropenem should be strictly controlled.Amikacin and beta-lactamase inhibitors are better choice for empirical antibiotic therapy in the treatment of infections caused by A. baumannii.