目的 分析天津市人民醫(yī)院2013-2015年抗菌藥物使用情況和病原菌耐藥性，分析抗菌藥物用量與細(xì)菌耐藥性的相關(guān)性，指導(dǎo)臨床合理用藥。方法 統(tǒng)計(jì)天津市人民醫(yī)院2013年1月-2015年12月病原菌的分布、耐藥性和抗菌藥物的使用情況，并采用Pearson法對(duì)病原菌的耐藥性與抗菌藥物用量的相關(guān)性進(jìn)行分析。結(jié)果 2013-2015年分離出病原菌25 134株，以革蘭陰性桿菌居多，其次為革蘭陽(yáng)性球菌，前5位分別為大腸埃希菌、肺炎克雷伯菌、銅綠假單胞菌、鮑曼不動(dòng)桿菌、凝固酶陰性葡萄球菌。金葡菌屬對(duì)青霉素、紅霉素耐藥率偏高；糞腸球菌對(duì)絕大多數(shù)所測(cè)試抗菌藥物的耐藥率均顯著低于屎腸球菌。鮑曼不動(dòng)桿菌對(duì)大多種抗菌藥物的耐藥率明顯上升，對(duì)碳?xì)涿瓜┑哪退幝试鲩L(zhǎng)迅速。銅綠假單胞菌的耐藥情況較好。應(yīng)用抗菌藥物用藥頻度（DDDs）排名前5位集中在頭霉素、哌拉西林鈉他唑巴坦、頭孢菌素類(lèi)，其中頭霉素類(lèi)藥物頭孢西丁、頭孢米諾連續(xù)3年均居前5位。特殊級(jí)抗菌藥物比阿培南、亞胺培南DDDs增長(zhǎng)迅速。鮑曼不動(dòng)桿菌對(duì)哌拉西林他唑巴坦、美羅培南的耐藥率與其DDDs顯著相關(guān)（P<0.05）；大腸埃希菌、肺炎克雷伯菌對(duì)頭孢西丁的耐藥率與其DDDs顯著相關(guān)（P<0.05）；其余病原菌耐藥率與DDDs的相關(guān)性較小，無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論 天津市人民醫(yī)院2013-2015年住院抗菌藥物監(jiān)控指標(biāo)均達(dá)標(biāo)，部分病原菌耐藥性呈持續(xù)下降趨勢(shì)，但隨著頭霉素類(lèi)和碳?xì)涿瓜╊?lèi)抗菌藥物的大量使用，細(xì)菌耐藥形勢(shì)依然嚴(yán)峻，需加強(qiáng)臨床抗菌藥物的使用管理和細(xì)菌耐藥性監(jiān)測(cè)。

Objective To investigate the application of antibiotics and bacterial resistance in Tianjin Union Medical Center from 2013 to 2015, and to probe into the correlation between the drug resistance of pathogenic bacteria and the dosage of antibiotics, so as to provide guidance for rational drug use in clinic. Methods The distribution, drug resistance of pathogens, and usage of antibiotics in Tianjin Union Medical Center from January 2013 to December 2015 were collected. The correlation between the drug resistance of pathogenic bacteria and the dosage of antibiotics were analyzed by Pearson method. Results There were 25 134 strains which Gram negative bacilli were the most, and followed by Gram positive bacteria. The top 5 of the target pathogens isolated were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter bauman coli, coagulase negative staphylococcus. The drug resistance rate of Staphylococcus aureus to penicillin and erythromycin was high. The resistance rate of Streptococcus faecalis aginst the vast majority of the tested antibiotics was significantly lower than that of Enterococcus faecium. The resistant rate of P. aeruginosa to the large variety of antimicrobial agents increased significantly, and the drug resistance rate of the strains increased rapidly. The drug resistance of P. aeruginosa was better. Defined daily doses (DDDs) of cephamycins, cephalosporins and piperacillin tazobactam were high, and cefoxitin and ceftazidime ranked in the top 5 from 2013 to 2015. DDDs of special class of antibacterial drugs imipenem and biapenem increased rapidly. Drug resistance of P. aeruginosa against piperacillin tazobactam and meropenem DDDs were significantly correlated (P<0.05), correlation of E. coli and K. pneumoniae resistant rate against cefoxitin DDDs were significant (P<0.05), but there were no statistical significances between the rest of the resistance rate of bacteria and DDDs. Conclusions The monitoring indicators of antibiotics for inpatients are up to standard in Tianjin Union Medical Center from 2013 to 2015, and the resistance of some pathogenic bacteria is in a decline tendency. With the large consumption of cephamycins and carbapenems, the current situations of bacterial resistance remains are severe which needs to strengthen the management of clinical use of antibiotics and monitor of bacterial resistance.