2013-2017年医院铜绿假单胞菌临床分布及耐药性变迁

Distribution and changes of drug resistance of Pseudomonas aeruginosa from 2013 to 2017

目的分析铜绿假单胞菌的样本来源、科室和年龄分布、构成比及耐药性变迁。方法收集2013―2017年医院感染患者检出的铜绿假单胞菌,进行菌种鉴定和抗菌药物敏感性试验,采用WHONET 5.6软件对其构成比和常用抗菌药物的耐药率进行数据分析。结果 2013-2017年分离的铜绿假单胞菌菌株标本来源均以痰标本为主,且逐年递增,而脓标本呈逐年递减趋势;铜绿假单胞菌以烧伤科、呼吸科、神经外科和ICU为主,以60岁以上患者为主,均在60%左右;2013―2017年铜绿假单胞菌构成比分别为9.78%、12.78%、13.14%、14.03%、13.41%;铜绿假单胞菌对多黏菌素B耐药率较低;左氧氟沙星和环丙沙星的耐药率在2013―2015年呈增长趋势,2016年呈降低趋势;对亚胺培南、美罗培南的耐药率升高。结论铜绿假单胞菌构成比呈增长趋势,其中痰标本增长幅度较大,细菌对多黏菌素B和阿米卡星有高敏感性,但对碳青霉烯类抗菌药物的耐药性进一步增加,希望临床医生密切关注耐药变迁,合理选用抗菌药物。

OBJECTIVE To investigate some profiles of Pseudomonas aeruginosaincluding sources of samples,distribution of departments and age,constituent ratio,and changes of drug resistance.METHODS P aeruginosa strains isolated from nosocomial infection patients from 2013 to 2017 were collected for bacterial identification and antimicrobial susceptibility test.WHONET 5.6 software was used to analyze the constituent ratio and drug resistance rate of common antimicrobial agents.RESULTS The specimen source of P aeruginosa strains isolated during2013-2017 was dominated by sputum samples,and the proportion showed an increasing trend,whereas the proportion of pus samples showed a decreasing trend.The dominant departments were burns surgery department,respiratory department,neurosurgery department and ICU.The constituent ratios of Pseudomonas aeruginosafrom2013 to 2017 were 9.78%,12.78%,13.14%,14.03%and 13.41%,respectively.The resistance rate of P aeruginosa to polymyxin B remained the lowest.The resistance rate to levofloxacin and ciprofloxacin increased from 2013 to 2015,but decreased in 2016.The resistance rates to imipenem and meropenem increased.CONCLUSION The constituent ratio of P aeruginosa increased year by year,in particular the sputum specimens grew markedly.P aeruginosa had relatively high sensitivity to polymyxin B and amikacin,but its resistance rate of carbapenem increased further.We hope the clinicians could pay attention to the changes of drug resistance,and choose antimicrobial agents rationally.