铜绿假单胞菌医院感染的调查与耐药性分析

Prevalence of Pseudomonas aeruginosa nosocomial infections and drug resistance

目的探讨铜绿假单胞菌医院感染的分布情况及耐药性。方法收集2015年1月-2016年12月铜绿假单胞菌医院科室临床分离株170株,采用琼脂扩散法(K-B法)对170株铜绿假单胞菌进行药敏试验,分析铜绿假单胞菌的标本来源分布及对15种常用抗菌药物的药敏率,并探讨抗菌药物单独用药与联合用药对铜绿假单胞菌的治疗效果。结果铜绿假单胞菌标本来源主要为呼吸道标本,检出率为59.4%,其次为尿液,检出率为12.4%,且铜绿假单胞菌医院感染主要集中在ICU、神经外科、呼吸内科等科室;药物敏感试验显示铜绿假单胞菌对临床中常用的15种抗菌药物均有严重耐药性,其中对氨苄西林/舒巴坦的耐药率最高,达到74.7%,其次为头孢噻肟,耐药率为70.6%,对环丙沙星的耐药率最低,为18.8%;6组联合抗菌药物协同累加率为43.52%~88.47%,联合抗菌治疗效果最佳为头孢他啶与环丙沙星,达到92.9%,其次为环丙沙星与哌拉西林他唑巴坦钠的联合,达到78.8%,抗菌药物联合应用敏感率与单独用药敏感率呈现显著差异(P<0.05)。结论铜绿假单胞菌有较高的耐药性,应加强临床监测与控制,对铜绿假单胞菌给予抗菌药物联合给药,增强体外抗菌活性。

OBJECTIVE To explore the distribution and drug resistance of Pseudomonas aeruginosacausing nosocomial infections.METHODS A total of 170 clinical P.aeruginosaisolates were collected from Jan 2015 to Dec 2016,the drug susceptibility testing was carried out for the 170 strains of P.aeruginosa by using disk diffusion method（K-B method）,the specimens sources and drug susceptibility rates to 15 types of commonly used antibiotics were observed,and the effects of single medication and combined medication on treatment of the P.aeruginosainfections were explored.RESULTS Among the P.aeruginosastrains isolated from the specimens,59.4% were isolated from respiratory tract specimens,and 12.4% were isolated from urine specimens.The P.aeruginosainfection were prevalent in the ICU,neurosurgery department and respiratory medicine department.The drug susceptibility testing indicated that the P.aeruginosastrains were highly resistant to the 15 types of commonly used antibiotics,the drug resistance rates to ampicillin-sulbactam was the highest（74.7%）,followed by cefotaxime（70.6%）,and the drug resistance rate to ciprofloxacin was the lowest（18.8%）.The collaborative cumulative rate of 6 groups of combined antibiotics ranged between 43.52% and 88.47%,ceftazidime combined with ciprofloxacin achieved the optimal therapeutic effect（92.9%）,followed by ciprofloxacin combined with piperacillin tazobactam sodium（78.8%）,and there was significant difference between the susceptibility rate of combined use of antibiotics and the single use of antibiotic（P〈0.05）.CONCLUSION The P.aeruginosa strains are highly drug-resistant,it is necessary to strengthen the clinical monitoring and control,carry out the combined medication for the P.aeruginosaand boost the in vitro antibacterial activity.