2010～2012年金昌地区老年呼吸系统感染患者铜绿假单胞菌耐药性变迁分析

Analyze Pseudomonas aeruginosa drug resistance changes in elderly patients with respiratory in-fection in Jinchang hospital of 2010 - 2012

目的调查甘肃省金昌地区住院老年呼吸系统感染患者铜绿假单胞菌（PAE）的临床分布及耐药性变迁，为临床合理治疗提供依据。方法收集金昌地区3所综合医院2010年1月～2012年12月住院的老年呼吸系统感染患者分离的PAE株，采用Kirby-Bauer琼脂扩散法进行药物敏感试验，以美国临床实验室标准化协会（CLSI）2010年标准判断临床分离株的药物敏感性，采用WHONET5．6软件进行统计分析。结果3年分离的360株PAE对12种常用抗菌药物的耐药性总体呈上升趋势。其对美罗培南的耐药率最低，为16．1％；耐药率最高的为左氧氟沙星（50．8％）。2012年较2010年，分离出的铜绿假单胞菌对头孢他啶、头孢吡肟、氨曲南、左氧氟沙星的耐药率上升趋势较明显，分别由20．2％、22．2％、34．3％和40．4％上升至42．6％、36．2％、42．6％和58．2％。检出泛耐药菌株18株（5．0％）。结论老年患者医院下呼吸系统感染APE的耐药现象普遍，总体呈逐年上升趋势，应加强细菌监测，及时了解耐药性变迁，防止泛耐药菌的产生，对临床合理应用抗生素，有效地控制医院感染具有十分重要的意义。

Objective To investigate the Pseudomonas aeruginosa clinical distribution and drug resistance changes in elderly patients with respiratory tract infection in Jinchang hospital in order to pro- vide the basis for clinical treatment. Methods The samples were collected from elderly patients with re- spiratory infections in three general hospitals in Jinchang city during Jan. 2010 to Dec. 2012 and the Pseudomonas aeruginosa strains were isolated from the samples. Kirby-Bauer agar diffusion method was used to detect drug susceptibility of the isolated strains. The results were determined according to CLSI 2010 and analyzed by WHONET 5.6 software. Results There existed overall upward trend of the 360 i- solated Pseudomonas aeruginosa strains to 12 kinds of commonly used antimicrobial agents during the three years. The lowest resistance drug was meropenem（ 16. 1% ） and the highest resistance drug was levofloxacin（50.8% ）. The isolated Pseudomonas aeruginosa drug resistant rate to ceftazidime, cefepime, aztreonam, levofloxacin was 20.2% ,22.2% ,34.3% and 40.4% respectively in 2010 and that was lower than 42.6% ,36.2% ,42.6% and 58.2% in 2012.18 strains of multi-drug-resistant strains were isola- ted. Conclusion There exists a widespread drug resistance of Pseudomonas aeruginosa in elderly patients with lower respiratory tract infections and shows an increasing trend. Strengthen bacteria monitoring, timely understanding of drug resistance changes, prevent the multi-resistant bacteria forming, these will be benefit to clinical rational use of antimicrobial agents to control hospital infection.