摘要目的：分析抗菌药物管理前后重症监护病房（ ICU）中致病菌耐药率的变化趋势，以及抗菌药物使用强度与致病菌耐药率的相关性。方法回顾性分析2010至2014年泰山医学院附属医院ICU抗菌药物使用强度和同时期致病菌对常用抗菌药物的耐药率。利用自回归移动平均（ ARIMA）模型进行抗菌药物使用强度和细菌耐药率的互相关分析。结果 ICU总体抗菌药物使用强度从2010年的163．46 DDDs·100人－1· d－1逐年下降至2014年的68．20 DDDs·100人－1· d－1，呈下降趋势，其中喹诺酮类、咪唑类、碳青霉烯类、氨基糖苷类、其他β-内酰胺类、大环内酯类抗菌药物的使用强度下降明显。与之相伴随的是，2010至2014年主要致病菌对常用抗菌药物的耐药性存在较大范围的改善，并与抗菌药物使用量减少存在一定的正相关。但是，与2013年相比，2014年主要致病菌耐药状况的改善并不显著，反而出现细菌耐药率的增长，包括铜绿假单胞菌对环丙沙星以及鲍曼不动杆菌对阿米卡星、亚胺培南、美罗培南的耐药率。结论抗菌药物管理实施后，ICU中抗菌药物消耗明显下降，主要致病菌的耐药性得到一定程度改善，但部分菌株的耐药率出现反弹，应当引起重视。

abstractsObjective To investigate the changes of antibiotic resistance and its correlations with antibiotics use density (AUD) in intensive care unit (ICU) after implementation of antimicrobial stewardship. Methods Data on AUDs and synchronous antibiotic resistance in ICU of the Affiliated Hospital of Taishan Medical University during 2010 and 2014 were retrospectively reviewed.Autoregressive integrated moving average ( ARIMA) model was used to identify the correlation between AUDs and antibiotic resistance.Results The total AUD which stood at 163.46 DDDs· 100 person-1 · d-1 in the year 2010 decreased to 68.20 DDDs · 100 person-1 · d-1 in 2014, and the most significant decreases were found in quinolones, imidazole, carbapenems, aminoglycosides, other beta lactam and macrolides. Synchronously, a wide range of improvements in antibiotic resistance of major pathogens were also observed from 2010 to 2014, and the improvements were positively correlated with the decrease of AUDs.However, antibiotic resistance in 2014 was not significantly improved compared with that in 2013. The rate of ciprofloxacin resistance in Pseudomonas aeruginosa and the resistant rates of amikacin, imipenem, and meropenem in Acinetobacter baumannii even increased in 2014.Conclusions With the implementation of antimicrobial stewardship, antibiotic consumption in ICU was decreasing, and antibiotic resistance rate in major pathogenic bacteria was decreasing.But the rebound in antibiotic resistance in some types of bacteria was also observed and should be put on enough caution.