限制使用三代头孢菌素对肠杆菌科产超广谱 β- 内酰胺酶菌株比例的影响

Effect of restrictive use of third-generation cephalosporins on proportion of broad-spectrum β-lactamases-producing Enterobacteriaceae

摘要:

目的 了解限制三代头孢菌素使用对临床常见分离菌大肠埃希菌、肺炎克雷伯菌及奇异变形杆菌产 超广谱β- 内酰胺酶菌株比例的影响，为下一步实施更为有效的抗菌药物管理制度提供理论依据。方法 2012 年南通市第三人民医院针对住院患者采取限制三代头孢菌素使用策略，分别统计2011 ～ 2015 年青霉素类、 一二代头孢菌素、三代头孢菌素、碳青霉烯类及喹诺酮类、酶抑制剂复合制剂类，以及氨基糖苷类的抗菌药物 使用强度；统计5 年来大肠埃希菌、肺炎克雷伯菌及奇异变形杆菌产超广谱β- 内酰胺酶菌株比例。结果 三 代头孢菌素使用强度从26.1 下降到8.23，喹诺酮类以及氨基糖苷类药物使用强度也有所下降，一二代头孢菌素 和碳青霉烯类使用强度上升；产超广谱β- 内酰胺酶大肠埃希菌变化不大，产超广谱β- 内酰胺酶肺炎克雷伯 菌阶段性下降，产超广谱β- 内酰胺酶变形杆菌持续稳定下降，且与三代头孢菌素用量减少相关。结论 限制三 代头孢菌素可降低产超广谱β- 内酰胺酶肺炎克雷伯菌和变形杆菌的比例，该效应有一定的延时，如果采取 更为全面的抗菌药物控制策略，而不仅是限制某一类抗菌药物，则可避免“挤气球效应”，造成其他药物的使 用量增加。

Abstract:

Objective To investigate whether restriction of use of third-generation cephalosporins can reduce the proportions of broad-spectrum β-lactamases-producing Enterobacteriaceae such as Escherichia coli and Klebsiella pneumoniae, Proteus mirabilis so as to provide theoretical basis for antibiotic management strategy. Methods Restriction of use of third-generation cephalosporins has been performed in Nantong Third People’s Hospital since 2012. The intensity of use of antimicrobial agents such as penicillins, 1st-generation and 2nd-generation cephalosporins, 3rd-generation cephalosporins, aminoglycosides, carbopenems, quinolones and enzyme inhibitor compounds from 2011 to 2015 were compared, and the proportions of broad-spectrum β-lactamases-producing Escherichia coli and Klebsiella pneumoniae and Proteus mirabilis were calculated. Results The antibiotics use intensity of 3rd-generation cephalosporins decreased significantly from 26.1 to 8.23, that of aminoglycosides and quinolones also decreased significantly. The antibiotics use intensity of 1st- and 2nd-generation cephalosporins and carbopenems increased significantly. The proportion of broad-spectrum β-lactamases-producing Escherichia coli had little change, the proportion of broad-spectrum β-lactamases-producing Klebsiella pneumoniae reduced significantly before and after the intervention; the proportion of broad-spectrum β-lactamases-producing Proteus mirabilis gradually dropped accompanied with the decreased use of 3rd-generation cephalosporins. Conclusions Restriction of use of 3rd-generation cephalosporins can significantly decrease the proportion of broad-spectrum β-lactamasesproducing Klebsiella pneumoniae and Proteus mirabilis, but this effect has certain delay. If a more comprehensive antibiotic control strategy is used rather than focusing only on a single kind of antibiotics, “ the balloon-squeezing effect ” can be avoided to prevent increased use of other drugs.