黏液型和非黏液型铜绿假单胞菌临床分布和耐药表型分析

Clinical distribution and drug-resistant phenotype of mucoid and non-mucoid Pseudomonas aeruginosa

目的了解黏液型和非黏液型铜绿假单胞菌(pseudomonas aeruginosa,PAE)的临床分布及耐药性特点,为临床合理选择抗菌药物和预防控制院内感染提供依据。方法对2010-2013年济南军区总医院黏液型和非黏液型PAE的临床分布、耐药表型及药敏结果进行回顾性分析。结果 4年内共分离出1 465株PAE,黏液型PAE共44株(占3.0%),非黏液型PAE共1 421株(占97.0%);44株黏液型PAE除1例来自尿液外,其余均来自痰液标本,74.9%的非黏液型PAE标本分离自痰液;黏液型菌株医院感染患者的基础疾病主要是慢性呼吸系统疾病,占64.5%;非黏液型菌株则多见于术后感染和呼吸系统疾病患者,分别占25.8%、19.6%。44株黏液型PAE中,多重耐药菌占11.4%;而非黏液型PAE中多重耐药菌为19.0%;黏液型PAE对部分原本敏感的抗菌药物逐年产生耐药性,且各药的耐药率呈逐年上升趋势,但耐药率均较低;而非黏液型PAE的耐药率自2011年起逐年降低。结论 PAE分离标本以痰液为主,阳性感染者多为慢性呼吸系统疾病患者,与非黏液型PAE相比,黏液型PAE对抗菌药物的耐药性逐年增强。

Objective To understand the distribution characteristics and drug resistance of mucoid and non-mucoid P. aeruginosa （PAE）, so as to provide reference for rational use of antibiotics and infection control. Methods The isolation distribution, resistant phenotype and drug resistance of mucoid and non-mucoid PAE isolated from General Hospital of Jinan Military Region from 2010 to 2013 were retrospectively analyzed. Results Of all the 1 465 PAE isolated from clinical specimens in 4 years, 44 （3.0%） were mucoid PAE and 1 421 （97.0%） were non-mucoid PAE strains. 43 cases of mucoid PAE were isolated from sputum and 1 from urine. Of all the non-mucoid PAE strains, 74.9 percent of them were isolated from sputum. Mucoid PAE infections were common in the patients with respiratory diseases accounting for 64.5%, and the non-mucoid strains were common in the patients with postoperative infection and respiratory diseases with the isolation rates of 25.8% and 19.6%, respectively. Of the 44 mucoid PAE strains, the multidrug-resistant accounted for 11.4%, while the isolation rate of non-mucoid multidrug-resistant PAE was 19.0%. The resistant strains, which were sensitive to some drugs before, showed increase of drug-resistance for mucoid PAE year by year, but the resistance rate was lower than non-mucoid PAE. The resistance rate of non-mucoid PAE decreased gradually from 2011. Conclusion The main specimen of PAE is isolated from sputum. PAE infection mainly occurs in the patients with chronic respiratory disease. Comparing with non-mucoid PAE, the resistance rate of mucoid PAE is increasing year by year. Prevention of infection control should be enhanced, so as to avoid cross infection in hospital.