2013—2015年云南省铜绿假单胞菌耐药性分析

The resistance analysis of Pseudomonas aeruginosa in Yunnan province during 2013—2015

目的了解云南省2013—2015年分离的铜绿假单胞菌的耐药性及特征,指导临床合理用药,为院内感染的监测和预防提供指导。方法按照统一的方案对云南省24家医院分离的铜绿假单胞菌进行耐药性监测,根据2015美国临床实验室标准化协会(CLSI)的标准进行药敏结果的判读,用WHONET 5.6软件及SPSS 17.0统计软件进行数据分析。结果 2013—2015年共分离铜绿假单胞菌12690株,主要分离自呼吸道标本。铜绿假单胞菌对哌拉西林/三唑巴坦、头孢他啶、头孢吡肟、亚胺培南、美罗培南、庆大霉素及环丙沙星耐药率呈上升趋势,对其余抗生素耐药率无明显变化。儿童分离株耐药率低于成人和老年患者分离株;ICU分离株耐药率明显高于非ICU分离菌株;除哌拉西林/三唑巴坦、妥布霉素、环丙沙星和左氧氟沙星外,分离自血液标本的菌株耐药率均高于非血液标本。结论 3年来云南省铜绿假单胞菌的分离数量逐年增加,ICU患者耐药形势严峻且血液标本来源的菌株对多数抗生素的耐药率高于非血液标本来源的菌株。因此,应加强对铜绿假单胞菌耐药性的连续监测,尤其应加强对ICU及血液标本来源菌株的关注,从而指导临床合理用药。

Objective To investigate the distribution and resistance of clinical isolates of Pseudomonas aeruginosa from hospitals in Yunnan province,guide rational use of antibiotics in clinic,and provide evidence for monitoring and prevention of nosocomial infections.Methods The resistance of Pseudomonas aeruginosa collected from 24 hospitals in Yunnan were monitored according to the standard method.The results of antibiotics susceptibility were interpreted according to the standards of American clinical and laboratory standards institute in 2015（CLSI 2015）.The data were analyzed by the WHONET 5.6 software and the SPSS 17.0 statistical software.Results 12,690 isolates ofPseudomonas aeruginosa were collected during 2013-2015,which mainly came from respiratory tract specimen.The resistant rate to piperacillin-tazobactam,ceftazidime,cefepime,imipenem,meropenem,gentamicin and ciprofloxacin was rising,the resistant rate to other antibiotics had no obvious changes;the resistant rate to commonly used antibiotics in strains from children was lower than that of adults and the aged.The resistant rates of ICU isolates were significantly higher than those of non-ICU isolates;Except for piperacillin-tazobactam,to brarnycin,ciprofloxacin and levofloxacin,the resistant rate of strains isolated from blood samples was significantly higher than non-blood specimen.Conclusion The number ofPseudomonas aeruginosa detected was increasing during the three years.The resistant rate of ICU isolates was severe and the resistant rate of strains isolated from blood samples to most antibiotics surveyed was higher than that of non-blood isolates.Thus,we should strengthen the surveillance of drug resistance of Pseudomonas aeruginosa,especially the strains from ICU and blood,so as to guide clinical rational drug use.