2013-2015年医院下呼吸道标本铜绿假单胞菌检出率及耐药性分析

Detection rate and drug resistance of Pseudomonas aeruginosa in lower respiratory tract infection in hospital in 2013-2015

目的分析医院患者下呼吸道感染铜绿假单胞菌的临床分布及耐药性,为临床合理用药提供参考。方法收集2013-2015年医院门诊和住院患者下呼吸道标本,依据《全国临床检验操作规程》将标本接种于血平板和麦康凯平板上,置于35℃CO2孵箱中培养,采用API20NE鉴定系统确定菌种,药敏试验采用纸片扩散法(K-B),数据采用WHONET 5.3统计软件进行分析。结果 2013-2015年医院患者共分离病原菌9 847株,检出铜绿假单胞菌1 257株,检出率12.77%,3年检出率分别为9.50%、13.70%、15.20%,呈逐年上升趋势;其中住院部患者检出1 147株占91.25%,以呼吸科ICU、外科ICU和神经科为主,分别占25.46%、20.29%和14.40%,而门诊患者检出110株占8.75%;2013年铜绿假单胞菌对氨曲南、亚胺培南和哌拉西林的耐药率最高,分别为32.52%、30.67%和30.37%,2014年对头孢哌酮、氨曲南和哌拉西林的耐药率最高,分别为31.68%、29.95%和29.31%,2015年对头孢哌酮、氨曲南和亚胺培南的耐药率最高,分别为34.54%、29.41%和29.03%,对阿米卡星的耐药率3年内始终保持最低,分别为15.34%、14.36%和13.47%。结论 2013-2015年铜绿假单胞菌引起的下呼吸道感染呈逐年上升趋势,治疗时应充分考虑铜绿假单胞菌耐药性分布的变化和特点,减少碳青霉烯类抗菌药物使用,合理应用阿米卡星和头孢哌酮/舒巴坦。

OBJECTIVE To analyze the drug resistance and clinical distribution of Pseudomonas aeruginosain hospital caused lower respiratory tract infection,so as to provide reference for rational use of drugs in hospital.METHODS Samples in lower respiratory of patients in the department of outpatients and inpatients of hospital from Jan.2013 to Dec.2015 were collected,which were inoculated on blood plate and Macconkey tablet followed by National Clinical Laboratory Procedures and cultured in CO2 incubator under 35℃.API20 NF was used to identify bacteria,and K-B was used for drug sensitivity test.WHONET 5.3was used for data analysis.RESULTS A total of 9847 strains of P.aeruginosa were isolated in from the hospitalized patients 2013~2015,and 1 257 strains of P.aeruginosa were isolated,the isolation rate in each year was 9.50%,13.70%,15.20%,with an increasing trend year by year.A total of 1 147 strains were isolated from the patients in department of inpatients,accounting for91.25%,mainly in Department of Respiration ICU,Surgery ICU and Neurology,accounting for 25.46%,20.29%,and 14.40%,while 110 strains detected from the department of outpatients,accounting for 8.75%.In2013,the top 3drugs resistance rate of Pseudomonas aeruginosa were aztreonam,imipenem and piperacillin,accounting for 32.52%,30.67%and 30.37%respectively.In 2014,the top three were cefoperazone,aztreonam and piperacillin,accounting for 31.68%,29.95%and 29.31%respectively,and in 2015 cefoperazone,aztreonam and imipenem,accounting for 34.54%,29.41% and 29.03% respectively,while the resistance rate to amikacin kept the lowest in these three years which were 15.30%,14.30% and 13.50%respectively.CONCLUSIONThe hospital lower respiratory tract infection induced by P.aeruginosa has an increasing trend yearly from 2013 to 2015.The changes and characteristics of drug resistance of P.aeruginosashould be paid more attention in the treatment to reduce the use of antibiotics like carbapenem,and promote the rational use of amikacin and cefoperazone/sulbactam.