铜绿假单胞菌目标性监测及抗菌药物使用分析

Targeted monitoring of Pseudomonas aeruginosa and analysis of utilization of antibiotics

目的了解医院感染铜绿假单胞菌的临床科室分布、耐药性变化及相应抗菌药物的使用情况,为临床合理选用抗菌药物提供依据。方法采用K-B纸片扩散法进行抗菌药敏试验,采用限定日剂量(DDD)、用药频度(DDDs)等指标,按季度对抗菌药物的使用情况进行分析。结果全年共检出铜绿假单胞菌989株,耐碳青霉烯类铜绿假单胞菌175株,占该菌种的17.7%;感染耐碳青霉烯类铜绿假单胞菌患者男性126例占72.0%,女性49例占28.0%;年龄≥71岁有86例占49.1%;耐碳青霉烯类铜绿假单胞菌分离自ICU84株占48.0%,居首位;其次是神经外科和康复科,分别占19.4%、12.0%;标本主要来源于痰液及咽拭子,占85.7%,居首位;铜绿假单胞菌在4个季度中:对替卡西林/克拉维酸、亚胺培南耐药率均>50.0%;对阿米卡星敏感率均>70.0%;对妥布霉素敏感率均>80.0%;敏感率最高的是多黏菌素B,为99.1%～100.0%;13种抗菌药物各季度DDDs排序前5位的是左氧氟沙星注射液、注射用头孢吡肟、注射用哌拉西林/舒巴坦、左氧氟沙星片、注射用头孢哌酮/舒巴坦。结论对重点感染科室要加强耐药性监测,合理使用抗菌药物,延缓细菌耐药性产生。

OBJECTIVE To learn the clinical distribution and the drug resistance of Pseudomonas aeruginosaand the usage of relevant antibiotics so as to provide the basis for reasonable clinical use of antibiotics.METHODS The drug susceptibility testings were conducted by K-B methods.The use of antibiotics was analyzed in terms of quarters using DDD and DDDs.RESULTS Of totally 989strains of P.aeruginosaisolated in a whole year,there were 175（17.7%）strains of carbapenem-resistant P.aeruginosa;there were 126（72.0%）cases of male patients with carbapenem-resistant P.aeruginosainfections and 49（28.0%）cases of female patient;there were 86（49.1%）cases of patients aged more than 71years.Of totally the carbapenem-resistant P.aeruginosa,84（48.0%） strains were isolated from ICU,ranking the first place,followed by the neurosurgery department（19.4%）and the respiration department（12.0%）.The sputum and the throat swab were the predominant specimens sources,ranking the first place（85.7%）.The drug resistance rates of the P.aeruginosaisolated in the four seasons were more than 50.0% resistant to ticarcillin/clavulanic acid and imipenem,the drug resistance rate to amikacin was over 70.0%;the drug susceptibility rate to tobramycin was over 80.0%;the drug susceptibility rate to polymyxin B was the highest,varying between 99.1%and 100.0%.Of the 13antibiotics tested,the levofloxacin injection,cefepime infection,piperacillin/sulbactam injection,levofloxacin tablets,and cefoperazone/sulbactam injection ranked the top five DDDs in each season.CONCLUSIONIt is necessary to strengthen the monitoring of drug resistance in the key departments and reasonably use antibiotics so as to prevent the bacterial resistance.