骨伤科患者铜绿假单胞菌感染分布及耐药性变迁

Distribution and drug resistance evolution of Pseudomonas aeruginosa in pathogenic bacterial infection in orthopedics department

目的探讨铜绿假单胞菌（PAE）在骨伤科患者感染病原菌中的分布及耐药性,为临床合理用药与控制骨伤科患者感染提供依据。方法收集2008年1月-2012年12月临床各科室住院患者的各类细菌培养标本17109份,病原菌培养鉴定依据卫生部《全国临床检验操作规程》,使用美国BD-PhoenixTM100全自动细菌鉴定仪及其配套的试剂盒进行常规鉴定,药敏试验采用纸片扩散（K-B）法,结果判定参照美国临床实验室标准化研究所（CLSI）标准执行,采用EXCEL进行数据的录入,数据以百分率表示。结果共分离出病原菌11 153株,革兰阳性球菌3 773株占33.8%,革兰阴性菌7 380株占66.2%;检出PAE 2 239株,检出率为20.1%,占革兰阴性菌的30.3%;PAE对美罗培南、阿米卡星、哌拉西林/他唑巴坦、亚胺培南、左氧氟沙星耐药率较低,分别为12.3%、15.3%、17.4%、17.6%、27.6%,耐药率为30.0%～40.0%的抗菌药物有头孢他啶、哌拉西林、阿莫西林/克拉维酸、氨曲南,对氨苄西林、头孢唑林、氨苄西林/舒巴坦耐药率达85.0%。结论 PAE是骨伤科患者感染的重要致病菌,5年间其对常用抗菌药物耐药率呈上升趋势,临床应根据PAE的生物学特性和骨伤科患者感染特点,采取相应的预防与治疗措施,加强细菌的耐药性监测及时掌握细菌的耐药性变迁,有效地控制骨伤科患者PAE感染的发生。

OBJECTIVE To investigate the distribution and drug resistance of Pseudornonas aeruginosa （PAE） in the pathogenic bacterial infection in orthopedics department, so as to provide guide for clinical medication and prevention. METHODS A total of 17 109 various bacteria specimens were isolated from hospitalized patients from Jan. 2008 to Dec. 2012, cultured according to National Clinical Laboratory Procedures, identified by BD- PhoenixTM100 and tested with K-B method. RESULTS Totally 11 153 strains of pathogens were isolated, among which there were 3 773 （33.8%） strains of gram-positive cocci, 7 380 （66.2 %） strains of gram-negative bacilli. There were 2 239 （20.1 %） strains of P. aeruginosa, accounting for 30.3 % of the gram-negative bacilli. The drug resistance rates of P. aeruginosa to meropenem, amikacin, piperacillin/tazobactam, imipenem, levofloxacin were low, respectively 12. 3%, 15. 3%, 17. 4%, 17. 6% and 27. 6%. The drug resistance rates of P. aeruginosa to ceftazidime, piperacillin, amoxicillin/clavulanic acid, aztreonam were between 30.0% and 40.0%. CONCLUSION P. aeruginosa is an important pathogenic bacterium in the orthopedics department. Its tendency of drug resistance rate to general antibiotics has been rising in the five years. According to the biological characteristics of P. aeruginosa and infection trait in the orthopedics department, the clinic should adopt corresponding precaution and therapeutic measures to strengthen drug resistance surveillance and keep track of drug resistance evolution, which can effectually control the infection of P. aeruginosa in the orthopedics department.