Study On Relationship Between Bacteria Tolarence And Antibacterial Application In A Tertiary Hospital

BackgroundAntibacterial drugs can inhibit or kill pathogenic micro-organism, which plays a crucial role in the clinical treatment of the infectious diseases. Along with the largely and chronically using of antimicrobials, Almost all kinds of bacteria to the rate of drug resistance to antibiotics ascended significantly, and the detection rate of methicillin-resistant staphylococcus aureus (MRSA) is as high as 50% in China. Gram-negative bacteria is the main pathogens of nosocomial infection, especially the enterobacteria bacteria which produce the Extended Spectrum Beta-Lactamases (ESBLs), and multidrug resistance(MDR) even the most serious pan-drug resistance(PDR) bacteria. The development of drug resistance, makes the clinical treatment of selection and application of antibiotics has become increasingly difficult, considerable research revealed that selective pressure of antimicrobial long-term or abuse application is the main factor that lead to bacterial resistance. There is a correlation between the antimicrobial defined daily dose system(DDDs) and the bacterial drug resistance, and studies have also found that change the empirical use of antimicrobial drugs may reduce the happening of bacterial resistance. In order to improve the diagnosis and treatment of infectious diseases, let clinical doctors have a better understanding of the bacterial drug resistance factors and trends and make treatment more accurately, reduce the nosocomial infection, this topic has analyzed the clinical isolates and its drug resistance in a certain grade-three general hospital, and then researched the correlation between them and antimicrobial usage, so as to provide reference for rational use of antimicrobial agents.ObjectivesTo analyze the composition and variation of pathogens isolated from inpatients in Second Affiliated Hospital of Bengbu Medical College from 2012 to 2015 four-year, and study drug resistance of each common bacteria. Combined with the usage of antibiotics and the change of antimicrobial resistance rate, we could analyze the correlation between frequency of drugs use and the change of common pathogenic bacteria resistance in clinical, which optimizes clinical use of antibacterial agents and effectively controls or delays the drug-resistance to guide the reasonable clinical drug-usage.MethodsTo collect the various pathogens from clinical in the Second Affiliated Hospital of Bengbu Medical College from 2012 to 2015, perform statistical the source of the patient’s specimen, the basic situation, susceptibility test results and others. Based on monitoring result, the paper analyses the distribution change and the possible resistance trend of pathogens. Drug-resistant, also known as resistance, which can be divided into acquired resistance and natural resistance according to their mechanism, and this article focuses on the acquired resistance. Used of HIS system in hospital to retrieve the antibiotics’type, number, amount, etc., calculated the use frequency of various antibacterial agents (DDDs) and total use frequency through the defined daily dose (DDD) method. Selected DDDs value of various antibiotics types from January 2012 to December 2015 and the resistant rate changes of clinical common pathogens during January 2012 to December 2015 to statistical analysis used the Excel 2003, and then explore the relevance of the total use frequency of antibiotics and resistance rates.Main ResultsWe isolated 3481 strains pathogenic bacteria from clinical samples within four years, among them, the number of gram-positive bacteria was 1071,constituted 30.77%,and gram-negative bacteria whose quantity was 2401,constituted 69.23%. The proportion of gram-negative bacteria were higher every year, was 77.74%,66.44%,63.73% and71.74% respectively, it had no significant changes. The majority is Escherichia coli (ECO), followed by the epidermis staphylococcus, pneumonia gram Reber fungus and Pseudomonas aeruginosa. The growth of Escherichia coli and epidermis staphylococcus have increased significantly, the verdigris pseudomonad had shown a sudden sharp rise over the last two years, which is worth us paying attention especially. At the same time, the proportions of enterobacterium, citrobacter and several pseudomonas have reduced year by year, streptococcus pneumonia also displayed a decreasing tendency in recent years, but staphylococcus aureus had changed little.The drug resistance rates of Escherichia coli, klebsiella were extremely high in penicillin, lincomycin and rifampicin than those in others, reached or closed to 100%; they had strong sensitivity to imipenem/cilastatin, but showed the depressed resistance rate; they were sensitive to meropenem with high sensitivity; the drug resistance rate of cefepime was up to 10%-50% also. But, the Meropenem of cefoperazone/sulbactam and piperacillin/tazobactam were under 10%.There had appeared teicoplanin-resistant strains in Escherichia coli already. Pseudomonas aeruginosa was almost 100 percent resistant to penicillin and cefazolin, kept the high sensitivity and no-significant variation to cefoperazone/sulbactam and amikacin. Enterobacter had nearly 100% sensitivity to imipenem/cilastatin and meropenem, but the resistance rate of cefoperazone/sulbactam, piperacillin/tazobactam, cefepime and amikacin were under 20%. S. aureus, S. saprophyticus, S. epidermidis and enterococci were with increased gradually resistant rate to most antibiotics, maintained a low level of resistant rate to amikacin, and had higher sensitive rate to piperacillin/tazobactam and cefoperazone/sulbactam. enterococci was also tested it in 2014 and 2015; resistant strains were also seen in teicoplanin or inezolid. Methicillin-resistant staphylococcus aureus (MRSA) all showed susceptibility to Vancomycin and teicoplanin, but not detected the strains which resistant them. The correlations between total DDDs of the antimicrobial agents and resistance rate of escherichia coli or klebsiella pneumonia was statistically significant, had positive correlation with ESBLs detection rates but with no statistically significant.Conclusion & SuggestionThese survey findings show that, the correlations between total DDDs of the antimicrobial agents and resistance rate of escherichia coli or klebsiella pneumonia was statistically significant, had positive correlation with ESBLs detection rates but with no statistically significant. The whole resistance rate of pseudomonas aeruginosa was correlated positively with antibacterials total DDDs. So reducing the misuse of antimicrobials is urgently required. We should insist monitoring the pathogenic bacteria and be properly selected based on drug sensitivity test in clinical treatment. There is possibility of resistance or moderate gram-negative bacteria infection exists in the clinical experience, piperacillin/tazobactam or cefoperazone/sulbactam or amikacin should be selected; the carbapenems are normally kept for severe infection. As for suspected novel gram-positive cocci infection, should choose ciprofloxacin, cefoxitin, piperacillin/tazobactam, amikacin or levofloxacin; as for severe infection, we suggest using the vancomycin or inezolid.