肿瘤患者铜绿假单胞菌医院感染的临床特点与耐药性

Clinical characteristics and drug resistance of Pseudomonas aeruginosa causing nosocomial infection in tumor patients

目的探讨肿瘤患者铜绿假单胞菌医院感染的临床特征及对抗菌药物的耐药性特点，为临床医师预防与治疗医院感染提供实验室参考依据。方法调查2009年1月-2012年12月288例肿瘤患者发生铜绿假单胞菌感染临床资料，所有试验操作严格遵循《全国临床检验操作规程》中的临床微生物学检验有关规定进行，无菌手法采集感染性标本进行细菌培养和菌种鉴定；抗菌药物的耐药性检测采用K—B法操作，药敏数据采用WHONET最新软件进行统计分析。结果肿瘤患者各种感染性标本中培养获得288株铜绿假单胞菌，对阿米卡星、亚胺培南、美罗培南、头孢哌酮／舒巴坦和哌拉西林／他唑巴坦等抗菌药物的耐药率〈15．0％；对头孢噻肟、哌拉西林的耐药率〉40．0%；对其他抗菌药物耐药率均在20．0％～35．0％，检出耐亚胺培南铜绿假单胞菌21株，检出率7．3％，未发现泛耐药铜绿假单胞菌。结论县级基层医院肿瘤患者医院感染铜绿假单胞菌的耐药率比较严重，尽管耐药率低于大城市综合医院铜绿假单胞菌耐药率，但仍然应该提高防范意识，贯彻落实卫生部颁发的《抗菌药物临床应用管理办法》，控制细菌耐药性快速增长的危险倾向。

OBJECTIVE To approach clinical characteristics and drug resistance of Pseudomonas aeruginosa （P. aeruginosa） causing nosocomial infection in tumor patient, so as to offer the reference for clinical prevention and treatment. METHODS The clinical data from 288 cases of tumor patients with nosocomial infection caused by P. aeruginosa from Jan. 2009 to Dec. 2012 were collected. According to National Guide to Clinical Laboratory Procedures, the infective specimens were collected aseptically for bacterial culture and identification in the routine methods. The suscepbbiliety testing was performed by K-B methods. RESULTS A total of 288 PAE were isolated from infective specimens. Susceptibility testing indicated that the resistance rate of P. aeruginosa was below 15 % to Amikacin , Imipenern , Meropenern , Cefoperazone/Sulbactam and Piperacillin/Tazobactam. Presistance rate to Cefotaxime and Piperacillin, nes above 40 % Resistance rates to the other six antibiotics varied between 20 % to 35 %. Pan-resistant strains was not found. 21 of imipenem resistaht were found, accounting for 7. 3 %. CONCLUSION Resistance of P. aeruginosa causing nosocomial infection in tumor patients is severe in basic-level hospitals in the comotres, Although the resistant rate is lower than those in comprehensive hospitals in big cities. Precaution consciousness should be raised. The Management of Clinical Application of Antibiotics issued by the ministry of health should be strictly implemented. The tendency of bacterial resistance should be controlled.