耐亚胺培南铜绿假单胞菌的临床感染现状及耐药性分析

The clinical distribution and drug resistance of imipenem-resistant pseudomonas aeruginosa

目的探讨医院耐亚胺培南铜绿假单胞菌（IRPA）的临床感染现状及耐药性，为临床医师诊断与治疗，合理用药提供科学依据。方法回顾f生分析山东大学附属省立医院2011年2月至2013年12月IRPA感染的临床资料；采用常规方法对临床分离的239株IRPA进行鉴定，采用纸片扩散法进行药敏试验，结果根据美国临床和实验室标准协会（CLSI）规定进行判断，对IRPA检出率和耐药率进行分析。结果IRPA主要分布在重症监护病房、神经外科、呼吸内科，分别占24．3％（58／239）、18．4％（44／239）、15．9％（38／239）；在各类标本中的检出率以痰液、尿液、脓液分泌物较高，分别占50．6％（121／239）、15．9％（38／239）、10．9％（26／239）；IRPA对多黏菌素B耐药率最低为0，对阿米卡星、哌拉西林／他唑巴坦、头孢他啶耐药率相对较低，分别为27．6％（66／239）、36．4％（87／239）,41．0％（98／239）；耐药率〉95．0％的有亚胺培南、氨苄西林、氨苄西林／舒巴坦、氯霉素、头孢唑林、四环素、阿莫西林／克拉维酸、头孢噻肟、美罗培南。结论：RPA医院感染和多药耐药性现象极为严重，应加强耐药性监测，强化合理使用抗菌药物的意识和管理，严防IRPA耐药株的产生与流行。

Objective To investigate the nosocomial status and drug resistance of imipenem-resistant pseudomonas aeruginosa（IRPA） to provide evidence for clinical diagnosis, treatment and the rational use of antibiotics. Methods The clinical data of IRPA hospital infection were analyzed by a retrospective analysis ; totally 239 strains of IRPA were identified by the routine methods. Drug sensitivity was determined by kirby-bauer methods and the resuhs were judged according to American Clinical and Laboratory Standards Institute（CLSI） regulations. Results IRPA was mainly distributed in the department of intensive care unit, neurosurgery and respiratory de- partment of internal medicine, accounting for 24.3% （58/239）, 18.4% （44/239） , 15.9% （38/239） corre-spondingly. In all types of samples, the detection rate in sputum, urine, pus secretion accounted for 50.6% （ 121/ 239 ） , 15.9% （38/239） , 10.9% （26/239） respectively. The drug resistance rate of IRPA to polymyxin B was 0, compared to 27.6% （66/239）, 36.4% （ 87/239 ） and 41.0% （98/239） to amikacin, piperacillin/tazobactam tazobactam, ceftazidime; drug resistance rate 〉 95.0% included imipenem, ampicillin, ampicillin/shubatan, chloramphenicol, cefazolin, tetracycline, amoxicillin/clavulanic acid, cefotaxime and meropenem. Conclusion IRPA hospital infection and multidru- resistance nhenomenon is serious.