2006년부터 2010년까지 한 병원의 집중치료실에서 분리된 Imipenem 내성 Acinetobacter baumannii의 비율과 Carbapenem 계열 항균제 처방의 상관관계
Correlation between Carbapenem Prescription Trends and Imipenem Resistance in Acinetobacter baumannii at an Intensive Care Unit between 2006 and 2010
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Carbapenem 내성 Acinetobacter baumannii가 전세계적으로증가하고 있다. Carbapenem 계열 항생제 사용의 증가가 imipenem 내성 A. baumannii의 증가에 영향을 미쳤을 것이라고 일반적으로 추정된다. 그러나 이에 대해서 통계적인 자료를 이용해서 밝힌연구는 거의 없다. 이에 본 연구에서는 2006년부터 2010년까지 경기도에 소재하는 한 병원에서 carbapenem 계열 항생제 처방량과집중치료실에서 동정된 imipenem 내성 A. baumannii 내성률의상관관계를 알아보았다. Carbapenem 계열 항생제 처방 자료들은병원 전산기록을 통해 2006년부터 2010년까지의 자료를 WHO ATC/DDD 단위로 얻었다. 같은 기간의 미생물검사 자료들은 미생물검사실 정보 시스템인 WHONET (WHO, Geneva, Switzerland)프로그램을 이용하여 얻었다. Imipenem 내성 A. baumannii의비율은 2006년에는 4.3%에서 2010년에는 83.8%로 증가하였다(P<0.05; r2 =0.85). 같은 기간 carbapenem 계열 항생제 처방은2006년에 19.71 DDD/1,000 inpatient-days에서 36.99 DDD/1,000inpatient-days로 증가하였다(P<0.05; r2 =0.95). Carbapenem 계열항생제 처방량의 증가와 imipenem 내성 A. baumannii의 증가는상관관계가 있었다(P<0.05; R=0.90). Carbapenem 계열 항생제처방의 증가와 imipenem 내성 A. baumannii의 증가 사이에 유의한 상관관계가 있음을 보여주었다.
Abstract
Carbapenem resistance in Acinetobacter baumannii has increased rapidly worldwide. It is generally assumed that carbapenem prescription in a hospital has a significant impact on imipenem resistance in A. baumannii. However, there are few studies validating these assumptions with statistical data. We performed a surveillance study to investigate the relationship between carbapenem prescription trends and the imipenem resistance rate of A. baumannii in an ICU. Carbapenem prescription data in the WHO anatomical therapeutic chemical (ATC)/defined daily dose (DDD) format for the period from 2006 to 2010 were obtained from the hospital electronic pharmacy records. In the same period, microbiologic data for the ICU were extracted from the laboratory information system. Imipenem resistance rates of A. baumannii increased from 4.3% in 2006 to 83.8% in 2010 (P <0.05; r2=0.85). Carbapenem prescription had increased from 19.71 DDD per 1,000 inpatient-days in 2006 to 36.99 DDD per 1,000 inpatientdays in 2010 (P <0.05; r2=0.95). Carbapenem prescription rate correlated with the imipenem resistance rate in A. baumannii (P <0.05; R=0.9). The results of our study demonstrated a correlation between carbapenem prescription trends and imipenem resistance in A. baumannii.
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