西安某院近8年铜绿假单胞菌的临床分布特征及耐药性分析

Analysis on distribution features and drug resistance of clinically isolated Pseudomonas aeruginosa in a hospital of Xi’an in the past eight years

目的了解西安市某三甲医院近8年的铜绿假单胞菌临床分离株的分布特征以及其对常用药物的耐药情况,为合理选用抗菌药物和监控、预防院内感染提供参考依据。方法对2012—2019年门诊及住院患者送检微生物培养标本中的分离菌进行分离培养、鉴定以及药敏试验,按美国临床和实验室标准化协会(CLSI)2019标准判断药敏。结果共分离出铜绿假单胞菌6437株,检出率为10.97%;标本主要来源于痰80.30%,分泌物4.41%及全血4.21%;主要分布于呼吸内科[呼吸重症监护室(RICU)]28.80%、急诊重症监护室(EICU)14.76%及重症监护室(ICU)10.36%。铜绿假单胞菌对多黏菌素(3.9%)、妥布霉素(7.1%)、哌拉西林/他唑巴坦(7.0%)、阿米卡星(12.2%)及左氧氟沙星(12.7%)的耐药率稍低外,对其他常用的抗菌药物存在较高的耐药率,特别是碳青霉烯类抗菌药物。耐碳青霉烯类铜绿假单胞菌的检出率逐年减少,从2012年的43.10%下降到2019年的23.93%,但其他多重耐药菌从2015年后检出率逐渐升高,从2015年的4.55%增长到2019年的6.97%。结论铜绿假单胞菌主要分离自痰标本,分布在各类ICU,检出率呈下降趋势;但多重耐药铜绿假单胞菌检出率却出现增长趋势。除了左氧氟沙星、环丙沙星和头孢吡肟,铜绿假单胞菌对其他抗菌药物的耐药率均高于同时期的中国细菌耐药监测网(CHINET)的报道,因此需要重视医院感染控制工作,特别是重症监护病房的多重耐药菌。

Objective To provide evidence for the control and rational selection of antibiotics and prevention of nosocomial infections,the distribution and drug resistance of Pseudomonas aeruginosa(PA)isolates from patients in a 3A grade hospital of Xi’an were investigated and analyzed in recent eight years.Methods The PA were cultured,isolated and identified from different specimens of outpatients and inpatients from 2012 to 2019.The antimicrobial susceptibility tests were performed to determine the drug-resistant phenotype,and then the susceptibility test results were interpreted according to the guidelines of the Clinical and Laboratory Standards Institute(CLSI)2019.Results A total of 6437 PA clinical isolates were collected,accounting for 10.97%.The main sample sources of PA were sputum(80.3%),secretion(4.41%),and blood culture(4.21%),which mainly distributed in respiratory[including respiratory intensive care unites(RICU)]28.80%,emergency intensive care unites(EICU)14.76%and intensive care unites(ICU)10.36%.The PA isolates showed low drug resistance ratios to polycolistin(3.9%),tobramycin(7.1%),piperacillin/tazobactam(7.0%),amicacin(12.2%),and levofloxacin(12.7%).The detection rate of carbapenem-resistant Pseudomonas aeruginosa(CRPA)decreased year by year,from 43.10%in 2012 to 23.93%in 2019,but CRPA were still relatively high.At the same time,the detection rate of multiple drug resistant Pseudomonas aeruginosa(MDRPA)gradually increased after 2015,from 4.55%in 2015 to 6.97%in 2019.Conclusion PA was mainly isolated from sputum specimens and distributed in ICU wards,the detection rate was decreased,while the MDRPA was increased.Except levofloxacin,ciprofloxacin and cefepime,the drug resistance rate of other drugs was higher than those from CHINET reports in the same period.Therefore,infection control in hospital,especially the MDRPA in ICU,deserved more attention.