铜绿假单胞菌ESBLs检测及其流行病学分析

Detection of pseudomonas aeruginosa ESBLs and epidemiological analsysis.

目的 为了解本地铜绿假单胞菌的耐药性及其分布情况 ,为控制和预防其流行提供科学依据。 方法 采用双纸片琼脂扩散法 ,测定 2 0 0 0～ 2 0 0 3年从临床标本分离的铜绿假单胞菌的ESBLs检测及药敏结果 ,比较该菌在病房、标本间的检出率、ESBLs阳性率、耐药性差异及年间变化。 结果 铜绿假单胞菌在各年检出的革兰氏阴性病原菌中均居第二位或第三位 ,住院标本检出率为 15 9%是门诊标本检出率 6 1%的 2 6倍 ,以五官耳鼻喉科、放疗科、康复科、心血管内科、老干病房、呼吸内科、心胸外科的呼吸道、伤口创面分泌物检出率较高。ESBLs总阳性率为 3 6 3 % ,前三年逐年下降 ( 5 7 1%～ 6 7% ) ,2 0 0 3年又呈上升趋势 ( 71 4% ) ( χ2 =3 3 163 ,P <0 0 5 )。对临床常用的氯霉素、丁胺卡那霉素、环丙沙星等均产生了很高的耐药性 ,最高达 10 0 % ,且ESBLs阳性菌株的耐药率明显高于阴性菌 (P <0 0 5或 0 0 1) ;对复合抗生素优力欣也已产生了较高的耐药性 ,对碳青霉烯类抗生素———泰能 ,复合抗生素舒普深、特治星的耐药性目前较低。 结论 铜绿假单胞菌ESBLs阳性菌在医院广泛存在 ,对临床常用的抗生素有很高的抗药性 ;应加强重点科室物表、空气和ESBLs监测及常住病人痰标本的送检 。

Objective In order to detect the extendedspectrum-β-lactamases(ESBLs) of Pseudomonas aeruginosa and its resistance to the antibiotics, also to find out the distributing in the ward of hospital and sample, so as to supply some science data for controlling and preventing the expanding of ESBLs Pseudomonas aeruginosa and the breaking out of infection with it in clinical. Methods Using double-disc Agar diffuse, We have detected the ESBLs and resistance of Pseudomonas aeruginosa isolated from all sample in past four years, and have analysed the difference of isolating rate of Pseudomonas aeruginosa and its ESBLs positive rate among the samples, wards and years. Results Pseudomonas aeruginosa is second or third pathogeny of all Gram negative pathogeny isolated from our hospital. The isolating rate(15.9%) of in-patient sample is 2.6 times higher than of out-patient (6.1%). there are significant difference of it among the samples and wards, Most of Pseudomonas aeruginosa are isolated from the sputum and secretion of wound at the departments of geriatrics, respiratory medicine and Cardio- thoracic surgery. The ESBLs positive-rate of Pseudomonas aeruginosa is 36.3% and it's fall down from 2000-2002(57.1% to 6.7%),but rise at 2003 year(71.4%).The Pseudomonas aeruginosa, especially the ESBLs+ species, have acquired high level resistance to the Chloramphenicol, Amikacin and Ciprofloxacin which in common use in the clinic, lower level resistance to the Imipenem, Piperacillin/tazobactam and Cefoperazone / sulbactan. Conclusions Pseudomonas aeruginosa had became the main pathogeny of nosocomial infection and the ESBLs + species exist widely inthe environment of hospital and also got a high level resistance to many kinds antibiotiacs, which in common use in clinic. To control and prevent Pseudomonas aeruginosa and its ESBLs + species expanding and breaking out in clinical, It is the essential measure to enhance the surveillence of air、environment and ESBLs at the high dangerous ward and to increasethe microbiologic detection with sputum of the patients who stay at the ward for long time and to strengthen the seclusion on the one who show the positive result and to use antibiotics according the result of resistance-test.