铜绿假单胞菌的流行病学及耐药性研究

Study on epidemiology and antibiotics resistance of Pseudomonas aeruginosa

目的调查铜绿假单胞菌的流行情况、耐药性,并探讨治疗用药。方法采用回顾性方法统计分析某三级甲等医院2007-2009年检出的铜绿假单胞菌标本来源、感染科室分布及耐药性。结果铜绿假单胞菌阳性检出率为23.63%;其最常出现在痰标本中,占92.56%;多分布在老年病房,占31.23%,其次是呼吸病房,占25.01%;铜绿假单胞菌表现为高度耐药和多药耐药,耐药率最高的抗菌药物是氨苄西林、氨苄西林/舒巴坦、阿莫西林/克拉维酸、头孢唑林、头孢西丁、头孢呋辛、头孢曲松、磺胺甲噁唑/甲氧苄啶,其耐药率均>99.0%,对头孢哌酮/舒巴坦、阿米卡星的耐药率较低,分别为21.73%、11.02%,对头孢噻肟、亚胺培南、左氧氟沙星的耐药率均>50.00%,其中对亚胺培南耐药率为59.14%,亚胺培南耐药菌株均表现对β-内酰胺类、喹诺酮类等多种抗菌药物的泛耐药。结论铜绿假单胞菌常导致患者严重的肺部感染,其泛耐药菌株使抗菌药物面临着选择压力;治疗上根据药敏试验选择抗菌药物,经验用药可考虑选用头孢哌酮/舒巴坦,阿米卡星。

OBJECTIVE To investigate the epidemic situation,antibiotics resistance and treatment of Pseudomonas aeruginosa.METHODS P.aeruginosa isolated from the hospital from 2007 to 2009 were retrospectively analyzed according to specimen source,infection in different departments and drug-resistance.RESULTS The dection rate of P.aeruginosa was 23.63% during the three years,while the most common samples was sputum（92.56%）.P.aeruginosa infection were found mostly in the department with senior patients,accounting for 31.23%,followed by the respiratory ward 25.01%.P.aeruginosa showed high-drug resistance and multi-drug resistance,P.aeruginosa showed the highest rate of resistance with more than 99.0% to ampicillin,ampicillin/sulbactam,cefazolin,cefoxitin,ceftriaxone,sulfamethoxazole compound.P.aeruginosa showed the lowest rate of resistance to amikacin and cefoperazone/sulbactam with 11.02% and 21.73%.ceftriaxone,cefotaxime,imipenem,levofloxacin resistant rate were more than 50.00%.Resistance rate to imipenem was 59.14%.imipenem-resistant acinetobacter show resistance to most of β-lactam antibiotics and quinolonos,we call this broad antibiotics-resistant acinetobacter.CONCLUSIONS P.aeruginosa is the most common bacteria in respiratory tract infection,treatment to P.aeruginosa is facing selection pressure because of broad antibiotics-resistant acinetobacter.cefoperazone /sulbactam and amikacin are the best choice for the experience treatment.It suggests that the clinicians should choose antibiotics rationally according to drug susceptibility test.