3年医院铜绿假单胞菌耐药性变迁

Change of antimicrobial resistance in Pseudomonas aeruginosaduring the past three years

目的调查2009年1月-2011年12月医院感染铜绿假单胞菌(PAE)的临床特点及耐药性变迁,为临床医师控制医院感染选择用药提供实验室依据。方法医院感染标本的采集、PAE培养、鉴定严格按照卫生部规定的《全国临床检验操作规程》进行;药敏试验和结果评价采用WHO及CLSI推荐的K-B法进行;所有数据处理采用WHONET5.4-5.5软件分析。结果 487株PAE医院感染的高检出部位主要为呼吸道感染259例占53.2%;泌尿道98例占20.1%,皮肤创面感染50例占10.3%;PAE对大多数临床抗菌药物的耐药率逐年上升;3年耐亚胺培南铜绿假单胞菌分别检出18、16、23株,阳性率分别为10.7%、11.0%、13.4%;耐药率最高的抗菌药物是磺胺甲噁唑/甲氧苄啶,均>65.0%;3年耐药率均>35.0%的抗菌药物有氨曲南、头孢噻肟、环丙沙星、左氧氟沙星、哌拉西林、庆大霉素;而耐药率均<20.0%的抗菌药物有阿米卡星、亚胺培南、美罗培南和头孢哌酮/舒巴坦;增长幅度较大的药物是头孢噻肟和环丙沙星。结论 3年临床流行的铜绿假单胞菌对常用抗菌药物的耐药性逐年上升,临床微生物室应密切配合医院感染管理部门,加强监控力度,预防与遏制PAE耐药性日益上升的不良趋势。

OBJECTIVE To understand the clinical characteristics and change of antimicrobial resistance of Pseudo- monas aeruginosa causing nosocomial infections during the three years from Jan. 2009 to Dec. 2011 so as to provide laboratory data for the clinical medication. METHODS According to National Guide to Clinical Laboratory Procedures issued by Ministry of Public Health, the infective specimens were collected to perform the bacterial culturation and identification. The drug-sensitivity testing was performed by K-B methods recommended by WHO and CLSI. The testing results were assessed. The WHONET 5. 3-5. 5 software was used to analyze the data. RESULTS Of 487 strains of 1）. aeruginosa causing nosocomial infections, there were 259 （53. 2%） cases of patients with respiratory tract infections, 98 （20.1%） cases with urinary tract infections, and 50（10.3%） cases with skin and mucous membranes infections. The drug susceptibility testing results indicated that the drug resist- ance to most commonly used antibiotics was increasing year by year. There were respectively 18 strains, 16 strains and 23 strains of imipenem-resistant P. aeruginosa detected in the three years, the detection rates were 10.7%, 11.0%, and 13. 4%, respectively. The drug resistance rate to sulfamethoxazole/trimethoprim was the highest （more than 65.0%）. The antibiotics with the drug resistance rates more than 35.0% included aztreonam, cefo- taxime, ciprofloxacin, levofloxacin, piperacillin and gentamincin, while the antibiotics with the drug resistance rates less than 20.0% included amikacin, imipenem, meropenem and cefoperazone/sulbactam; the drug resistance to cefotaxime and ciprofloxacin showed larger increase. CONCLUSION In the three years, the drug resistance of the clinical prevalent P. aeruglnosa to the commonly used antibiotics increased year by year. The clinical laborato- ry should work closely together with the hospital infection department and strengthen the monitoring so as to pre- vent and control the adverse increase of drug resistance of P. aeruginosa.