【摘要】 目的 探讨重症加强护理病房(ICU)医院获得性肺炎患者碳青霉烯类药物用药频度(DDDs)及DDDs值对鲍曼不动杆菌(AB)耐药性的影响。方法 回顾性分析2010年1月1日～2018年12月31日收治的2 700例ICU医院获得性肺炎患者的病例资料，主要从纤维支气管镜灌洗液或痰标本中分离AB,用全自动微生物鉴定系统及最小抑菌浓度法分析AB对碳青霉烯类药物的耐药性。2010～2018年各季度AB对碳青霉烯类药物耐药率的变化及其与DDDs值的关系分别采用折线图和Spearman检验进行分析。结果 2010～2018年2 700例ICU医院获得性肺炎患者总分离菌株为3 943株，其中AB占10.58%(417/3 943),分离率逐渐升高。2010～2018年，AB对碳青霉烯类药物的耐药率逐渐升高，敏感率逐渐下降，其中2014～2018年的耐药率均超过50.00%,而其对应的敏感率均低于50.00%;2010～2018年，每年的第4季度和下一年的第1季度间，AB对碳青霉烯类药物的耐药率均会出现一个小高峰。2010～2018年ICU医院获得性肺炎患者的注射用亚胺培南/西司他丁、美罗培南的DDDs值均呈逐年上升趋势，且与AB的耐药率均呈正相关(r值分别为0.461、0.587,P<0.05)。结论 碳青霉烯类药物的DDDs值与ICU医院获得性肺炎患者AB的耐药率有关。更多还原

【Abstract】 Objective To investigate the defined daily doses(DDDs) of carbapenems in patients with hospital acquired pneumonia in intensive care unit(ICU),and the effect of DDDs value on the drug resistance of Acinetobacter baumannii(AB).Methods The clinical data of 2 700 patients with hospital acquired pneumonia in ICU from January 1 2010 to December 31 2018 were retrospectively analyzed.AB was mainly isolated from bronchoscope lavage fluid or sputum samples.The drug resistance of AB to carbapenems was analyzed by automatic microbial identification system and minimum inhibitory concentration method.Broken line chart was used to analyze the change of drug resistance rate of AB to imipenem/cilastatin and meropenem for injection in each quarter from 2010 to 2018.Spearman test was used to analyze the correlation between DDDs value of carbapenems and drug resistance rate of AB.The change of resistance rate of AB to carbapenems and its relationship with DDDs in each quarter from 2010 to 2018 were analyzed by broken line chart and Spearman test.Results A total of 3 943 strains were isolated from 2 700 ICU patients with hospital acquired pneumonia from 2010 to 2018,of which AB accounted for 10.58%(417/3 943),the separation rate increased gradually.From 2010 to 2018,the drug resistance rate of AB to carbapenems gradually increased, while the sensitivity rate gradually decreased.The drug resistance rate from 2014 to 2018 was more than 50.00%,while the corresponding sensitivity rate was less than 50.00%.From 2010 to 2018,the resistance rate of AB to carbapenems had a small peak during the fourth quarter of each year and the first quarter of the next year.The DDDs values of imipenem/cilastatin and meropenem for injection in ICU patients with hospital acquired pneumonia showed an increasing trend from 2010 to 2018,and were positively correlated with the drug resistance rate of AB(r=0.461,0.587,P< 0.05).Conclusion The DDDs value of carbapenems is closely related to the drug resistance rate of AB in ICU patients with hospital acquired pneumonia.更多还原