铜绿假单胞菌医院感染的耐药性分析及防治对策

Drug resistance of Pseudomonas aeruginosa causing nosocomial infection and prevention countermeasures

目的探讨铜绿假单胞菌在临床感染中的分布及其耐药性,为预防及抗感治疗提供科学依据。方法收集2009-2011年临床分离的铜绿假单胞菌感染患者标本,严格按照《全国临床检验操作规程》进行细菌培养鉴定;采用琼脂扩散法进行药敏试验,对病原菌的标本来源、感染科室分布及耐药性进行分析。结果 2009-2011年分别收集铜绿假单胞菌为243、260、204株,连续3年比例均>80.00%,其次为创面分泌物、血液及尿液等;感染科室主要分布在ICU、神经外科、呼吸内科,分别占49.36%、14.57%、12.59%;铜绿假单胞菌对头孢吡肟耐药率最低,其次是亚胺培南、哌拉西林/他唑巴坦、头孢他啶,耐药率呈逐渐下降趋势;多药耐药铜绿假单胞菌检出率为43.84%,泛耐药铜绿假单胞菌检出率为5.37%。结论铜绿假单胞菌的分布及耐药类型基本相似,亚胺培南、头孢他啶仍然是治疗铜绿假单胞菌感染的有效药物;应加强对铜绿假单胞菌的耐药性监测,指导临床合理应用抗菌药物,预防医院感染。

OBJECTIVE To study the distribution and drug resistance of Pseudomonas aeruginosa causing nosocomial infection so as to provide scientific basis for control and prevention of infection. METHODS The specimens were collected from the patients with P. aeruginosa infections between 2009 and 2011, then the bacterial culture and identification were performed in strict accordance with the National clinical laboratory operation procedures, the drug susceptibility testing was performed with the use of agar diffusion method, and the specimens sources and departments where the pathogens were isolated as well as the drug resistance were observed. RESULTS Totally 243 strains of P. aeruginosa were isolated in 2009, 260 strains in 2010, 204 strains in 2011, with the proportion more than 80.0% in the three consecutive years; the wound secretions, blood, and urine were the predominant specimens sources. Among the cases of P. aeruginosa infections, 49.36% were in the ICU, 14. 57% in the neurosurgery department, 12. 59~ in the respiratory medicine department. The drug resistance rate of the P. aeruginosa to cefepime was the lowest, and the drug resistance rates to imipenem, piperacillin-tazobactam, and ceftazidime showed a downw ard. The detection rate of multidrug-resistant P. aeruginosa was 43.84%, the pandrug-resistant P. aeruginosa 5.37 %. CONCLUSION The distribution of the P. aeruginosa is basically similar to the drug resistant phenotypes; imipenem and ceftazidime remain the susceptible antibiotics for the treatment of P. aeruginosa infection. It is necessary to strengthen the surveillance of drug resistance so as to guide the reasonable clinical use of antibiotics and prevent nosocomial infection.