The Correlation Between The Use Of β-lactams Quinolones And The Resistance Rate Of Four Gram-negative Bacilli

Objective:Study the correlation between the drug-resistant rate of gram-negative bacteria and the use of antibacterial drugs.Take the resistant of Escherichia coli for instance to explore the related clinical and drug-resistance factors.Provide evidence to clinical drug use.Methods:1.The correlation between the use of antibacterial drugs and bacterial resistance.A retrospective analysis method was used to collect the drug-resistant data of four gram-negative bacterias to several of antibiotics.The relative data were draft from the hospital inspection information system,by quarters of year 2014--2016.The Gram-negative bacterias included Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,and Acinetobacter baumannii,the antibiotics included β-lactam plus enzyme inhibitor,Second and third generation cephalosporins,Hydrocarbon fungi,Quinolones,Cephamycin drug.The hospital information system was used to count the defined daily doses(DDDs)of the above drugs.The process of collecting and cultivating the clinical bacterial specimen confirmed to the National Clinical Laboratory Procedures.The research adopted the automatic microbiological analysis system VTEK2-compact60 as the instrument,adopted the Blood AGAR plate,M-H tablet and Antibacterial drug sensitive paper as the agentias.The “defined daily dose”,which was recommended by World Health Organization,was conversed to DDDs,to represent the use of antibacterial drugs.Pearson theory was applied to analyze the correlation between the quarterly drug resistance rate and DDDs of antibacterial drugs by SPSS20.0.The degree of the correlation was determined by the magnitude of r.2.High-risk factors for nosocomial infection of ESBLs-producing Escherichia coli.A total of 6702 positive cases of Escherichia coli culture were collected during the above 3 years.396 cases of nosocomial infections and pre-medication were included according to the Notice on Issuing the Diagnostic Criteria for Hospital Infections(Trial),and they were divided into observation group(including 194 cases,ESBLs-positive)and control group(including 202 cases,ESBLs-negative),according to if or not they produced extendedspectrum β-lactamases(ESBLs).A total of 16 indicators were extracted,including gender,age,body mass index,length of hospital stay,diabetes,long-term use of hormones,agranulocytosis,use of immunosuppressants,admission to intensive care units,invasive procedures,creatinine clearance,rationality of pre-infection antimicrobials,total frequency of pre-infection antimicrobials,duration of pre-infection antimicrobial therapy,frequency of single-day use of antimicrobials before infection and susceptibility of bacteria to drugs used before infection.Logistics regression analysis was conducted for the two groups of data to analyze the risk factors of drug-resistant bacterial infection.Results:1.The correlation between the DDDs of antibacterial drugs and bacterial resistance.The overall bacterial resistance rate showed a steady or decreasing trend,but parts of the drug resistance rates of Escherichia coli and Acinetobacter baumannii showed an upward trend.The total DDDs of antibiotic drugs were on the rise.The Pearson correlation analysis of the antimicrobial drug DDDs and bacterial resistance rate in each quarter were statistically significant according to P<0.05.The sorting of the correlation of r values was(from big to small): ESBLs production rate of Escherichia coli and Cephalosporin DDDs(second and third generation)(P=0.001,r=0.812),ESBLs production rate of Escherichia coli and Piperacillin-sulbactam(P=0.002,r=0.805),Escherichia coli resistance rate and Biapenem DDDs(P=0.002,r=0.793),Escherichia coli resistance rate and Imipenem DDDs(P=0.003,r=0.782),ESBLs production rate of Escherichia coli and Cefuroxime DDDs(P=0.003,r=0.78),Escherichia coli resistance rate and Carbapenems DDDs(P=0.003,r=0.77),ESBLs production rate of Klebsiella pneumoniae and Piperacillinsulbactam DDDs(P = 0.012,r = 0.693),Escherichia coli resistance rate and Cephalosporin DDDs(second and third generation)(P = 0.016,r = 0.675),Escherichia coli resistance rate and Cefuroxime DDDs(P = 0.025,r = 0.641),Acinetobacter baumannii resistance rate and Moxifloxacin DDDs(P = 0.033,r = 0.615),Escherichia coli resistance rate and Meropenem DDDs(P = 0.042,r=0.594).The correlation between the dosage of other drugs and bacterial resistance rate was negative or not statistically significant.2.High-risk factors for nosocomial infection of ESBLs-producing Escherichia coli.OR by logistic regression analysis of the 16 indicators of observation group and control group was(big to small): the frequency of single-day use of antimicrobials before infection(P=0.030,OR=2.297),the susceptibility of bacteria to drugs used before infection(P=0.037,OR=0.609),the length of hospital stay(P=0.029,OR=1.015),which were statistically significant.They were high-risk factors for nosocomial infection of ESBLs-posotive Escherichia coli.Gender,age,body mass index,diabetes,long-term use of hormones,agranulocytosis,use of immunosuppressants,admission to intensive care units,invasive procedures,creatinine clearance,rationality of pre-infection antimicrobials,total frequency of pre-infection antimicrobials,and duration of pre-infection antimicrobial therapy were not statistical significance(P>0.05).Conclusions:1.After the special remediation of antibacterial drugs,the DDDs of antimicrobial drugs overall increased,but the bacterial resistance overall decreased.The clinical drug use tended to be reasonable,but the resistance rate of Escherichia coli and Acinetobacter baumannii partially increased.There was close correlation between the resistance rate of Escherichia coli and DDDs of antibiotics2.Clinical risk factors affecting the production of ESBLs positive Escherichia coli were as below(big to small): frequency of single-day use of antimicrobials before infection,susceptibility of bacteria to drugs used before infection and length of hospital stay.In conclusion,in the treatment of clinical infections,selecting appropriate antibiotics,ensuring an appropriate daily dose,and shortening the hospitalization time of patients could effectively reduce the risk of nosocomial infection of ESBLs-positive Escherichia coli.