医院感染铜绿假单胞菌的耐药性变迁分析

Analysis on changes of antimicrobial resistance of Pseudomonas aeruginosacausing nosocomial infections

目的调查医院感染标本中分离的铜绿假单胞菌(PAE)的感染部位分布及耐药性变迁,为临床治疗感染性疾病选择抗菌药物提供参考依据。方法采集两所医院2011年1月-2013年12月收治的感染患者不同部位标本,分析分离出的617株PAE分布及其耐药性,数据采用WHONET5.5-5.6软件进行分析。结果共分离617株PAE,以呼吸道标本为主,共333株占54.0%;3年PAE对多数抗菌药物的耐药率呈逐年上升态势,泛耐药PAE阳性检出率分别为9.3%、10.2%、14.6%;PAE对亚胺培南的耐药率分别为22.1%、22.8%、25.5%;耐药率<20.0%的有阿米卡星、妥布霉素、头孢哌酮/舒巴坦和哌拉西林/他唑巴坦;3年耐药率最高,且对磺胺甲噁唑/甲氧苄啶的耐药率均>60.0%。结论 3年PAE临床分离株对抗菌药物的耐药率总体呈现明显上升态势,医院行政管理领导应加大监管执行力,扭转国内细菌耐药性快速上升的恶劣倾向。

OBJECTIVE To investigate the distribution of infection sites and changes of antimicrobial resistance of Pseudomonas aeruginosa （PAE） isolated from infective specimens in our hospital during 3 years ,so as to provide evidence for clinical use of antimicrobial agents .METHODS Infective specimens from different infected sites of pa‐tients admitted and treated during Jan .2011 to Dec .2013 were collected ,617 isolated strains of PAE and their re‐sistance were analyzed .The testing results were analyzed by WHONET 5 .5‐5 .6 software .RESULTS The 617 PAE were mainly from respiratory tract specimens （333 ,54 .0% ） .During the 3 years ,the resistance of PAE to most antimicrobial agents was increasing and the detection rate of pan‐resistant PAE was 9 .3% ,10 .2% and 14 .6% in each year ,respectively .The resistance of PAE to imipenem was 22 .1% ,22 .8% and 25 .5% in the three years ,respectively .Antimicrobial agents with resistance rates less than 20 .0% were amikacin ,tobramycin , cefoperazone/sulbactam and piperacillin/tazobactam .The 3‐year resistance was the highest ,and the resistance rate to sulfamethoxazole/trimethoprim was ＆gt; 60 .0% .CONCLUSION Among the 3 years ,the overall resistance rate of clinically isolated strains of PAE to antimicrobial agents demonstrated a significantly increasing trend .Hos‐pital managers should strengthen the monitoring to change the rapidly increasing tendency of the bacterial resist‐ance rate .