2009-2011年重庆某三甲医院铜绿假单胞菌耐药性分析

Resistance surveillance of Pseudomonas aeruginosa in a chongqing Grade AAA hospital from 2009 to 2011

目的分析重庆医科大学附属第一医院2009年1月至2011年12月分离的铜绿假单胞菌对抗菌药物的耐药性,为临床合理治疗提供依据。方法采用纸片扩散法,以CLSI2010年标准判断临床分离株的敏感性,分析采用WHONET5.4及SPSS 18.0统计软件。结果 3年来共分离出铜绿假单胞菌853株,其中多重耐药铜绿假单胞菌165株,占19.3%。2011年较2009年,分离出的铜绿假单胞菌对阿米卡星、头孢他啶、头孢哌酮、环丙沙星的耐药率分别由17.8%、25.8%、77.9%、28.2%下降至11.9%、12.8%、25.9%、23.1%;对亚胺培南、β-内酰胺酶抑制剂复合物的耐药率分别由2009年的14.7%、5.3%～11.7%上升至2011年的22.5%、12.2%～14.4%。ICU多重耐药铜绿假单胞菌的检出率明显高于非ICU,且其在ICU与非ICU的检出率均有下降。多重耐药铜绿假单胞菌对头孢他啶、头孢吡肟、头孢哌酮耐药率分别由2009年的61.9%、57.1%、100%下降至2011年的39.0%、51.2%、70.7%;对亚胺培南、β-内酰胺酶抑制剂复合物的耐药率分别从2009年的33.3%、33.3%～35.7%上升至2011年的58.5%、43.9%～46.3%。结论该三甲医院多重耐药铜绿假单胞菌对亚胺培南和β-内酰胺酶抑制剂复合物的耐药率,2011年较2009年明显上升,加强细菌耐药性监测和抗菌药物分级管理,以利于指导临床合理使用抗菌药物及减少和控制细菌耐药的发生。

Objective To investigate the drug resistance of clinical isolates of P. aeruginosa from Jan. 2009 to Dec. 2011, and provide a reference for clinical treatment. Methods Disk diffusion test was used to study the antimicrobial susceptibility. Results were evaluated on the basis of CLSI 2010. WHONET 5.4 and SPSS 1 8.0 were used to analyze the data. Results During the past 3 years, 835 strains of P. aeruginosa were separated from all kinds of clinical samples, including 165 strains of multiple drug-resistant P. aerugino- sa, which accounted for 19.3%. The resistance rates of the isolated strains of P. aeruginosa to amikacin, eeftazidime, cefoperazone, ciprofloxacin was decreased from 17.8% , 25.8% , 77.9% , and 28.2% in 2009 to 11.9%, 12.8%, 25.9%, and 23. 1% in 2011, respectively. And its resistance rates to imipenem, beta- lactamase inhibitors composite was increased from 14.7%, 5.3% to 11.7% in 2009 to 22.5%, 12.2% to 14. 4% in 2011. The detection rate of multiple drug-resistant P. aeruginosa in the ICU was found significantly higher than that in the non-ICU, and the isolated strains of multiple drug-resistant P. aeruginosa, both from ICU and non-ICU, their detection rates were decreased. Compared with the resistance rates of multiple drug- resistant P. aeruginosa to ceftazidime, cefepime and cefoperazone in 2009, the resistance rates in 2011 were reduced from 61.9%, 57.1%, and 100% to 39.0%, 51.2%, and 70.7%, respectively. And the resistance rates to imipenem, beta-lactamase inhibitors composite in 2011 rose from 33.3%, 33.3% to 35.7% in 2009 to 58.5%, 43.9% to 46.3%, respectively. Conclusion The resistance rates of drug-resistant P. aeruginosa in our hospital to imipenem and beta-lactamase inhibitors composite are significantly higher in 2011 than in 2009.The monitoring of antibiotic resistance and the management of antibactics grading system should be strength- ened, so as to help guide the rational use of antimicrobials clinically, reduce and control the occurrence of bacterial resistance.