老年患者医院感染铜绿假单胞菌的耐药性分析

Analysis on antimicrobial resistance of Pseudomonas aeruginosa causing nosocomial infection in senile patients

目的调查了解荣军医院老年患者感染铜绿假单胞菌的耐药性特点,为临床治疗选择抗菌药物提供参考依据。方法选择2009年1月-2012年12月≥60岁老年住院患者各种临床感染标本中培养出的274株铜绿假单胞菌,感染标本的采集、细菌培养与鉴定严格按照卫生部《全国临床检验操作规程》进行,药敏试验和结果判断采用WHO和CLSI推荐的K-B法进行;所有数据采用WHONET5.5软件进行统计分析。结果医院老年患者发生铜绿假单胞菌感染的高发部位主要是呼吸道、泌尿道、皮肤黏膜,分别占54.4%、21.5%、10.6%;铜绿假单胞菌耐药率最高的是磺胺甲噁唑∕甲氧苄啶,达到61.7%;耐药率>40.0%的抗菌药物有氨曲南、头孢噻肟、庆大霉素、环丙沙星、左氧氟沙星、哌拉西林,敏感率>85.0%的抗菌药物有阿米卡星、亚胺培南、美罗培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦等。结论医院应贯彻执行卫生部颁发的《抗菌药物临床应用管理办法》,加强合理用药的监管措施,预防与控制老年患者医院感染,扭转铜绿假单胞菌耐药性无序增长的不良局面。

OBJECTIVE To investigate the clinical characteristic of antimicrobial resistance of Pseudomonas aeruginosa （PAE） causing nosocomial infections in senile patients in Rongjun hospital, so as to provide the reference for the clinical use of antibiotics. METHODS A total of 274 strains of PAE were cultured from the samples from inpatients older than 60 years old hospitalized from Jan. 2009 to Dec. 2012. Samples were collected, cultured and identified according to Diagnostic Criteria of Nosocomial Infection issued by Ministry of Public Health. The drug-sensitivity testing was performed by K B methods recommended by WHO and CI.SI. The WHONET 5.5 software was used to analyze the data. RESULTS Infection sites for elderly patients got PAE infections mainly were respiratory tract for 54.4%, then urinary tract for 21.5% and the skin and mucous membranes for 10.6%. The susceptibility testing results indicated that the antibiotic with the highest resistance rate was SMZ/TMP （61.7%）. The antibiotics with above 40% of resistance rate were aztreonam, cefotaxime, gentamycin, ciprofloxacin, levofloxacin and piperacillin. The antibiotics with above 85% of susceptibility rate were amikacin, imipenem, meropenem, eefoperazone/sulbaetam and piperacillin/tazobactam. CONCLUSION Hospitals should carry out Management of Clinical Application of Antibiotics issued by the ministry of health, strengthen the rational use of drugs, prevent and control the nosocomial infections in elderly patients and reverse the disorderly growth of resistance of PAE.