陈 爽，李君霞，焦雪峰，罗 琳

(河南省胸科医院药剂科，河南 郑州 450000)

ABSTRACTOBJECTIVE: To study the correlation between defined daily dose system(DDDs) of carbapenems antibiotics and detection of non-fermenting bacteria in intensive care unit(ICU), and to probe into the effective indicator of management of carbapenems, so as to provide basis for rational application of carbapenems. METHODS: The quarterly usage, number of bacterial strains and detection rate of non-fermenting bacteria of carbapenems antibiotics from Henan Provincial Chest Hospital from Jul. 2015 to Dec. 2016 were statistically analyzed, correlation analysis was conducted on these data including DDDs and per capita DDDs of carbapenems antibiotics, imipenem and meropenem, detection of strain number and detection rate of non-fermenting bacteria, acinetobacter baumannii, multi-drug resistant acinetobacter baumannii, pseudomonas aeruginosa and pseudomonas aeruginosa. RESULTS: The detection of non-fermenting bacteria was positively correlated with per capita DDDs of imipenem, the coeffients were respectively 0.898 and 0.910; and the detection of non-fermenting bacteria was negatively correlated with per capita DDDs of meropenem, the coeffients were respectively -0.835 and -0.815, with statistically significant difference(P<0.05). The detection of acinetobacter baumannii and multi-drug resistant acinetobacter baumannii were positively correlated with the capita DDDs of imipenem, the coeffients were respectively 0.815 and 0.816, 0.813 and 0.816, the differences were statistically significant (P<0.05). There was no statistical difference among other data (P>0.05). CONCLUSIONS: DDDs and per capita DDDs of carbapenems have correlation with detection of non-fermenting bacteria, especially for the acinetobacter baumannii. It is an effective indicator for monitoring of the rational drug application.

KEYWORDSCarbapenems; Detection; DDDs; Non-fermenting bacteria; Acinetobacter baumannii; Pseudomonas aeruginosa

非发酵菌是指一群不能利用葡萄糖或仅能以氧化形式利用葡萄糖的革兰阴性杆菌，大多为机会致病菌，近年来该类细菌在住院患者革兰阴性杆菌感染中的检出率明显升高，特别是鲍曼不动杆菌及铜绿假单胞菌，已成为引起重症加强护理病房(intensive care unit，ICU)危重患者医院感染的主要致病菌，其耐药程度比较突出，成为临床治疗感染的难点。碳青霉烯类抗菌药物已成为治疗非发酵菌特别是鲍曼不动杆菌及铜绿假单胞菌感染的首选药物。近年来，碳青霉烯类抗菌药物在河南省胸科医院(以下简称“我院”)ICU的使用增多，非发酵菌检出情况也在增多，特别是多重耐药的鲍曼不动杆菌及铜绿假单胞菌。本研究对我院ICU碳青霉烯类抗菌药物用药频度(defined daily dose system，DDDs)与非发酵菌特别是鲍曼不动杆菌及铜绿假单胞菌检出情况的相关性进行分析，以期为碳青霉烯类抗菌药物的管理及合理应用提供依据。

1 资料与方法

1.1 资料来源

收集2015年7月至2016年12月我院ICU送检验科标本中所有检出阳性菌株数据，共812株，其中非发酵菌183株，包括铜绿假单胞菌65株、鲍曼不动杆菌为76株及其他非发酵菌42株；提取同期我院ICU碳青霉烯类抗菌药物使用数据，目前我院仅有美罗培南、亚胺培南西司他丁2个品种。

1.2 方法

按季度统计非发酵菌检出菌株数，并计算相应菌株的检出率，检出率=检出相应菌株数/总检出菌株数×100%。以g为单位，按季度统计美罗培南、亚胺培南西司他丁的使用量。……