我院铜绿假单胞菌对β-内酰胺类抗生素的耐药性调查与控制策略

Analysis of drug resistance of Pseudomonas aeruginosa to β-lactams in hospital and control strategy

目的调查我院铜绿假单胞菌(PA)对β-内酰胺类抗生素的耐药性及其变迁情况,指导临床合理用药和控制耐药菌的产生.方法用17种β-内酰胺类抗生素对2001年～2003年病房临床分离的PA 1128株进行药敏实验.结果PA三年来对头孢他啶耐药率分别为26.38%、37.37%和25.39%;对头孢哌酮/舒巴坦的耐药率分别为2.27%、24.55%和15.77%;对头孢吡肟的耐药率2002年为25.49%,2003年为22.77%;PA对亚胺培南的耐药率分别为47.86%、39.90%和33.77%;对美罗培南的耐药率2003年为36.63%.结论β-内酰胺类抗生素对PA的耐药性已十分严重,对于PA的感染,应在药敏指导下用药,目前经验性治疗可选用头孢哌酮/舒巴坦或头孢吡肟,应该适当控制第三代头孢菌素和碳青霉烯类的使用.

Objective To investigate the change of antibiotic resistance of Pseudomonas aeruginosa (PA) to β-lactams in hospital for reference of clinical antimicrobial and drug-resistance control strategies. Methods Data were collected from 1128 clinical isolates during Jan.2001～Dec.2003. Drug sensitivity tests were made for 17 β-lactams. Results Drug-resistance rate of ceftazidime of each year was 26.38%, 37.37% and 25.39%; cefoperazone-sulbactam 2.27%, 24.25%, 15.77%; cefepime 25.49% (2002), 22.77% (2003); imipenem 47.86%, 39.90% and 33.77%; meropenem 36.63% (2003). Conclusion The drug resistance of PA to β-lactams is highly prominent. Antimicrobial treatment with PA infection should be guided by drug sensitivity test. While the choices for experimental treatment of β-lactams are cefoperazone-sulbactam and cefepime . The usage of the third generation cephalosporins and carbapenems should be strategically controlled.