ICU医院感染铜绿假单胞菌的耐药性分析

Drug resistance of Pseudomonas aeruginosacausing nosocomial infections in ICUs

目的探讨医院重症监护病房(ICU)抗菌药物使用及铜绿假单胞菌对常用抗菌药物的耐药性,为临床医师合理使用抗菌药物提供科学依据。方法细菌培养严格按《全国临床检验操作规程》进行,菌株鉴定采用VITEK-32全自动细菌分析系统,药敏试验采用纸片扩散法(K-B法),收集2013年1-12月ICU送检标本516份的临床资料进行统计,并分ICU常用抗菌药物的用药频度、使用强度。结果 ICU感染铜绿假单胞菌的耐药性非常严重,耐药率除对多黏菌素5.0%、氨曲南23.1%、亚胺培南28.9%、头孢哌酮/舒巴坦20.7%、头孢吡肟24.8%较低外,对其他抗菌药物耐药率均>30.0%;亚胺培南和美罗培南在ICU使用强度较高,分别为9.58和11.02AUD,并且铜绿假单胞菌的耐药率已分别达到28.9%和31.4%。结论抗菌药物的用药强度和细菌耐药之间存在一定的相关性,加强对耐药菌株的动态监测,通过局域网及时将铜绿假单胞菌的流行病学及耐药趋势向全院通报,采取针对性干预措施规范和合理抗菌药物的使用,防止细菌耐药性的产生,减少ICU医院感染。

OBJECTIVE To explore the use of antibiotics in the intensive care unit （ICU ） and observe the drug re‐sistance of the Pseudomonas aeruginosa to the commonly used antibiotics so as to provide scientific basis for rea‐sonable clinical use of antibiotics .METHODS The bacterial culture was carried out in strict accordance with Nation‐al Clinical Laboratory Operation Procedures ,the strains were identified by using VITEK‐32 automatic bacteria a‐nalysis system ,the drug susceptibility testing was performed with the use of disk diffusion method;the clinical data of 516 submitted specimens that were obtained from the ICU from Jan 2013 to Dec 2013 were statistically ana‐lyzed ,and the frequency of drug use and use density of the commonly used antibiotics were observed .RESULTS The drug resistance of the P .aeruginosa strains causing the infections in the ICU was very serious ;the drug re‐sistance rates to colistin ,aztreonam ,imipenem ,cefoperazone‐sulbactam ,and cefepime were 5 .0% ,23 .1% , 28 .9% ,20 .7% ,and 24 .8% ,respectively ,while the drug resistance rates to other antibiotics were more than 30 .0% ;the use density of imipenem was 9 .58 AUD in the ICU ,meropenem 11 .02AUD ;the drug resistance rate of the P .aeruginosa strains reached to 28 .9% and 31 .4% ,respectively .CONCLUSION The use density of antibi‐otics is to a certain degree associated with the drug resistance .It is an effective way to strengthen the dynamic mo‐nitoring of the drug‐resistant strains ,report the epidemiology of the P .aeruginosa and the tendency of drug resist‐ance to the hospital through local area network ,take the targeted interventions ,and reasonably use antibiotics so as to prevent the emergence of bacterial resistance and reduce the incidence of nosocomial infections in the ICU .