铜绿假单胞菌在高危病区临床分布时对抗生素耐药性分析

Analysis of Antibiotics Drug-resistance in the Clinical Distribution of Pseudomonas Aeruginose in the High-risk Stricken Area

目的了解铜绿假单胞菌(PAE)在高危病区的临床分布及对抗生素敏感性特点。方法①药敏试验采用K-B纸片扩散法,参照NCCLS标准给予药敏解释,采用χ2检验进行数据统计分析。②临床分布选择PAE首次培养阳性病历进行回顾性分析。结果①2006年PAE阳性菌株临床分布在呼吸内科、神经外科、ICU,分别占全院检出PAE菌株的20.0%、25.7%、15.7%。呼吸内科首次PAE阳性85.7%来自社区,神经外科高血压病脑出血患者占60.0%。②敏感性比较:对各高危病区分离到PAE对常用抗生素的敏感性分析发现,碳青霉烯类、头孢哌酮/舒巴坦、头孢他啶、头孢哌酮、氨曲南、哌拉西林无显著性差异(P>0.05);头孢吡肟、庆大霉素有显著性差异(P<0.05);阿米卡星、环丙沙星有非常显著性差异(P<0.01);美罗培南、头孢哌酮/舒巴坦对PAE抗菌活性优势明显。结论社区获得性感染等因素易造成高危病区的PAE群集,早期经验治疗需参考所在病区病原学和耐药资料,可控制抗生素敏感性下降速度。

Objective Understanding the clinical distribution of PAE in the high-risk stricken area and its characteristic of being sensitive to antibiotics. Methods （1） Test medication allergy by means of K-B scraps of paper diffusion, gave the explanations for medication allergy referring to NCCLS standard, adoptХ^2 examination to carry out statistical analysis. （2） Select the positive medical case in the first PAE in the clinical distribution to make retrospective analysis. Results （1） The clinical distribution of PAE positive bacterial strain in 2006 was in respiration internal medicine, neurosurgery, and ICU, respectively taking up 20.0%, 25.7% and 15.7% of the examined PAE bacterial strains in the whole hospital. In respiration internal medicine85.7% first positive PAE was coming from communities. The patients suffered from hypertension and brain bleeding in neurosurgery take up 60.0%.（2） Sensitivity comparison： By analyzing the sensitivity of the PAE obtained from high-risk stricken area to antibiotics in common use, it is found that there is no marked difference （P〉 0.05） among carbapenems, cefoperazoze/sulbactam, ceftazidime, cefoperazone, aztreonam, piperacillin; marked difference （P〈0.05） between cefepime and gentamicin; extremely marked difference （P〈0.01）between amikacin and ciprofloxacin; while meraopenem and cefoperazoze/sulbactam have marked preponderance in PAE antiseptics activity. Conclusion For PAE bacterium group in high-risk stricken area caused by acquired affection in communities and other factors, early experience treatment in reference to etiology in local stricken areas and the materials about drug resistance can control the falling speed of antibiotics sensitivity.