烧伤病房铜绿假单胞菌的流行性分析

Epidemiologic surveillance and analysis of Pseudomonas aeruginosa isolated from burn wards

目的监测不同来源、不同时期铜绿假单胞菌(PAE)的同源性,明确PAE在烧伤科的流行情况,以指导临床合理应用抗菌药物。方法采用重复序列聚合酶链反应(REP-PCR)技术,对烧伤科32株临床分离到的PAE进行基因分型,并用K-B纸片扩散法进行药物敏感试验。结果 32株PAE共分为7个基因型,其中A型13株,B型7株、C型6株、D和E型各2株、F和G型各为1株,A和C型菌株在不同来源、不同时期均分离到;32株PAE中,23株为多药耐药、8株为泛耐药菌株,对庆大霉素、哌拉西林、哌拉西林/他唑巴坦、氨曲南、头孢哌酮、头孢哌酮/舒巴坦、头孢吡肟、美罗培南的耐药率均>90.0%,对头孢他啶和环丙沙星的耐药率最低为25.0%。结论烧伤病房多年来存在PAE多型菌株流行,其对常用抗菌药物呈多药耐药或泛耐药,头孢他啶和环丙沙星是目前烧伤患者PAE感染的首选药物。

OBJECTIVE To survey the bacterial genotypes from different sources and periods and evaluate prevalence within the burn wards,we carried out this investigation of Pseudomonas aeruginosa as well as drug susceptibility test to perfect the guidance for antibiotics application.METHODS Thirty-two strains of P.aeruginosa isolated from the wound secretion and blood samples were collected from burn patients hospitalized in our department.The strains were typed by the repetitive extragenic palindromic PCR（REP-PCR） for genotype analysis,and tested by K-B for drug susceptibility analysis.RESULTS Totally 32 strains of P.aeruginosa were divided into 7 genotypes by REP-PCR,including 13 strains type A,7 strains type B,6 strains type C respectively;and for type D,E,2 strains for each,for type F,G,only one for each.We could test the type A and the type C from different sources and periods.Drug susceptibility test revealed that 23 strains were multi-drug resistant Acinetobacter baumannii（MDR）,8 strains were pan-drug resistant（PDR）,among which the resistance rate to gentamicin,piperacillin,piperacillin /tazobactam,aztreonam,cefoperazone,cefoperazone-sulbactam,cefepime and meropenem was respectively higher than 90.0%.The resistance rate to ceftazidime and ciprofloxacin was the lowest（25.0%）.CONCLUSION P.aeruginosa isolated from the burn wards do exist the prevalence strains in the recent years,which is developing to multidrug resistant or pan-drug resistant to commonly used antibiotics,and ceftazidime and ciprofloxacin would be the first choice for P.aeruginosa infection treatment of burn patients.