2016-2018年浙江省某医院铜绿假单胞菌对喹诺酮类药物的耐药性研究

Study on the drug resistance of pseudomonas aeruginosa to quinolones in a hospital of Zhejiang province in 2016-2018

目的收集2016-2018年浙江省某医院铜绿假单胞菌对喹诺酮类药物的耐药性变迁情况,以指导对铜绿假单胞菌合理的选择应用喹诺酮类药物。方法收集2016年1月~2018年12月在该医院接受住院治疗的铜绿假单胞菌感染患者230例,分别采集患者的血液、尿液、痰液、脓液等样本,进行病原菌培养与药敏试验,记录3年间医院铜绿假单胞菌对喹诺酮类药物的耐药情况。结果3年间230例住院治疗患者的临床样本中共分离出510株铜绿假单胞菌,痰液样本占比最高,依次为尿液样本、血液样本、脓液样本,其中包括同一位患者2种样本检出、同一位患者3种样本检出的情况,2种样本检出主要为痰液+尿液,3种样本检出主要为痰液+尿液+血液。3年间该医院230例检出铜绿假单胞菌的患者主要分布在重症监护室、呼吸科、神经内科,占比分别为34.78%、20.43%、17.39%。3年间该医院510株铜绿假单胞菌对主要喹诺酮药物均有不同程度耐药,其中对环丙沙星、左氧氟沙星耐药率相对较低。2016年、2017年、2018年铜绿假单胞菌检出率分别为30.39%(155/510)、32.55%(166/510)、37.06%(189/510),呈逐年递增趋势。2017年铜绿假单胞菌对主要喹诺酮类药物的耐药率较2016年整体降低,但在2018年耐药率下降趋势放缓。结论2016-2018年铜绿假单胞菌主要来自患者痰液、尿液及血液,重症监护室、呼吸科、神经内科是其主要定植科室,病原菌对喹诺酮类药物均有不同程度耐药,且不同时间段病原菌的感染可能呈上升趋势,临床应重视铜绿假单胞菌感染防控,合理给予患者喹诺酮类药物治疗。

Objective To understand the dynamic change in drug resistance of pseudomonas aeruginosa to major quinolones in a hospital from 2016 to 2018,and to provide guidance for the selection of quinolones to treat infections caused by pseudomonas aeruginosa.Methods 230 patients with pseudomonas aeruginosa infection confirmed by bacterial culture and treated in the hospital from January 2016 to December 2018 were selected and a total of 230 strains of pathogens were isolated.Blood,urine,sputum,pus and other samples of patients were collected,cultured and drug susceptibility test were performed.The drug resistance of pseudomonas aeruginosa to the major quinolones in the hospital for 3 years was recorded and analyzed.Results A total of 510 strains of pseudomonas aeruginosa were isolated,most of them(67.83%)were from sputum samples,then from urine samples,blood samples,pus samples and others,bacteria could be detected in two or three samples of one patient,mainly from sputum and urine,or sputum,urine and blood.During the study period,out of 230 patients,34.78%were from intensive care unit,20.43%from respiratory department and 17.39%from neurology department.The drug resistance of 510 strains of pseudomonas aeruginosa to major quinolone varied,the resistance rate to ciprofloxacin and levofloxacin was relatively low.In 2016,2017 and 2018,the detection rates of pseudomonas aeruginosa in the hospital were 30.39%(155/510),32.55%(166/510)and37.06%(189/510),which showed an up-ward trend.The overall resistance rate of pseudomonas aeruginosa to quinolones was lower in 2017 than that in 2016,while it went up in 2018.Conclusions Majority of strains of Pseudomonas aeruginosa are isolated from sputum,urine and blood samples of patients in ICU,respiratory and neurology departments in the hospital from 2016 to 2018.The drug resistance rate of pathogens to major quinolones varies.The control measures for pseudomonas aeruginosa infection in major departments should be proposed and patients should be treated with proper quinolones.