昆明医科大学第一附属医院铜绿假单胞菌感染的临床分布及耐药性分析

Analysis of Distribution and Drug Resistance of Pseudomonas Aeruginosa in Nosocomial Infection in the 1st Affiliated Hospital of Kunming Medical University

目的了解昆明医科大学第一附属医院近3 a铜绿假单胞菌(PAE)感染的临床分布及耐药性的变化,为临床治疗铜绿假单胞菌感染提供依据.方法对2010年至2012年昆明医科大学第一附属医院临床分离的铜绿假单胞菌按照统一方案,采用统一材料进行药物敏感试验.采用MIC法、KB法和判定标准(CLSI2012年版),进行耐药性监测,使用WHONET 5.5软件,进行统计分析铜绿假单胞菌的病区分布情况与耐药率及变化趋势,使用SPSS软件进行统计分析.结果 2010年、2011年、2012年分离出铜绿假单胞菌,分别为208株、260株和278株,3 a中共分离出746株铜绿假单胞菌,主要分离自痰液(79.8%),其次为咽拭子(7.6%)和尿液(6.2%);科室分布以ICU为主(32.4%),其次为干疗科(27.7%)、呼吸内科(12.2%)和神经外科(6.8%);3 a来铜绿假单胞菌总体耐药率除亚胺培南、头孢哌酮/舒巴坦和氨曲南外,其余均呈下降趋势,亚胺培南3 a耐药率分别为65.2%,74.2%和69.5%;头孢哌酮/舒巴坦耐药率分别为48.0%,48.7%和55.8%,氨曲南耐药率分别为72.2%,78.2%和72.4%;阿米卡星、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦对铜绿假单胞菌有较高的敏感性.结论铜绿假单胞菌是医院感染的重要感染源,ICU仍是监控重点;铜绿假单胞菌耐药情况比较严重;临床医生应根据药物敏感试验和本医院药监测情况合理选择抗菌药物,控制耐药菌株的流行及医院感染.

Objective To investigate the clinical distribution and the drug resistances of Pseudomonas aeruginosa （PAE） during past 3 years in the 1st Affiliated Hospital of Kunming Medical University, and to provide evidence for clinical treatment of PAE infection.Methods The isolated PAE strains from 2010 to 2012 in the 1st Affiliated Hospital of Kunming Medical University were identified and antimicrobial susceptibility tests were performed using the MIC and the KB method,and thus, the ward distribution and the drug resistance rates and the changing trend were respectively analyzed by WHONET 5.5 software, and statistically analyzed with SPSS 17.0 SOFTWARE. Results Within the three years, a total of 208 strains, 260 strains and 280 strains of Pseudomonas aeruginosa were isolated separately in 2010,2011and 2012. A total of 746 PAE strains were isolated in 3 years,in which the most common specimens were sputum （79.8%）, followed by the throat swab （7.6%） and the urine （6.2%） . When it came to the ward distribution , ICU was the primary, which accounted for （32.4%）, followed by the department of cadre sanatorium （27.7%）, the department of respiratory medicine （12.2%） and the department of neurosurgery （6.8%） . Besides imipenem, Cefoperazone-sulbactam and aztreonam, the others were obviously in a decreasing trend in drug resistances. In 2010, 2011 and 2012, the resistances rates of imipenem were （ 65.2%） , （ 74.2%） and （ 69.5%） , respectively, the resistances rates of Cefoperazone-sulbactam were （48.0%）, （48.7%） and （55.8%）, and the the resistances rates of aztreonam were （72.2%）, （78.2%） and （72.4%） . Amikacin,piperacillin-tazobactam,Cefoperazone-sulbactam were the most active antimicrobial agents against P.aeruginosa. Conclusions The PAE is an important source of infection, ICUs are the focus of interest for resistance monitoring and control. Antimicrobial resistance of PAE is fairly serious. Clinicians should select appropriate antibiotic therapy based on sensitivity testing.The therapeutic strategy should he adapted according to the local ecology of resistance to control the epidemic of the drug- resistance strains and hospital infection.