肺部感染铜绿假单胞菌耐药性与抗菌药物治疗效果分析

Prognosis and resistance analysis of patients infected with Pseudomonas aeruginosa in lung after using of antimicrobial drugs

目的:观察患者肺部感染铜绿假单胞菌对不同抗菌药物的耐药性及抗菌素治疗效果,为临床合理使用抗菌素治疗提供参考。方法:收集我院因肺部感染而住院患者所送检的痰液标本中分离出的568株铜绿假单胞菌株进行药敏试验监测,并对常用抗菌药物的耐药率进行分析,同时通过PCR法分析其整合子类型以及影响肺部患者预后的危险因素。结果:本组药敏实验结果显示,铜绿假单胞菌对氨苄西林、庆大霉素、头孢噻肟、头孢他啶、头孢吡肟及复方新诺明等耐药率均>62%,对亚胺培南耐药率<12%,而对联合抗菌药物阿洛西林、哌拉西林及阿奇霉素、头孢他啶的耐药率则均低于9%,其中多重耐药菌占总数的44%左右;另外发现检出的Ⅰ类整合子阳性菌对抗菌素药物的耐药率有直接相关性。结论:肺部感染铜绿假单胞菌患者对多种抗菌素有较高的耐药性,因此为了降低铜绿假单胞菌耐药率,临床上必须重视病原学检查和监测铜绿假单胞菌对抗生素的耐药性,待药敏实验结果确定后再合理选用抗菌素药物治疗。

Objective：To observe the antibiotic resistance and treatment effect of different antimicrobials in lung infection patients with Pseudomonas aeruginosa, and to provide a reference for antibiotic reasonable use in clinical practice. Methods： We collected sputum specimens form lung infection hospitalized patients from June 2010 to May 2013 , and performed susceptibility testing to isolated 568 strains of Pseudomonas aeruginosa, and analyzed resistance rates to commonly used antibiotics. Integration of sub--types and prognosis of patients with lung infection were analyzed by PCR. Results： Susceptibility testing shows the resistance rates of Pseudomonas aeruginosa to ampicillin, gentamicin, cefotaxime, ceftazidime, cefepime and cotrimoxazole were all greater than 62%, and less than 9~ to imipenem, while the resistance rates of combined antibacterial drugs Azlocillin, piperacillin and azithromycin, ceftazidime was less than 44%. We also found that integron --positive bacteria class I was directly correlated with resistance rates of antibiotic drugs. Conclusion： Pseudomonas aeruginosa in lung infection patients have a higher resistance to different antibiotics. In order to reduce the resistance rates of Pseudomonas aeruginosa, we must pay attention to the pathologic examination and the resistance of antibiotics to Pseudomonas aeruginosa in clinical practice, and select the appropriate antibiotic for treatment based on susceptibility results.