某教学医院三年间铜绿假单胞菌临床特征与耐药趋势分析

Analysis on Clinical Characteristic and Drug Resistance Trend of Pseudomonas Aeruginosa of Teaching Hospital in Three Years

目的了解本院分离的铜绿假单胞菌临床的分布特征和耐药性,为临床合理使用抗菌药物提供依据。方法收集本院2014年1月～2016年12月住院患者中分离的474株铜绿假单胞菌,使用VITEK-2 compact进行鉴定和药敏分析,应用WHONET 5.6和SPSS16.0软件进行统计分析。结果临床分离出革兰阴性菌2 407株,其中铜绿假单胞菌474株,检出率为19.7%。主要分离自痰液362株(占76.4%),其次为伤口分泌物,占7.6%;ICU及呼吸科的铜绿假单胞菌检出率分别为21.5%和18.3%;铜绿假单胞菌在历年的分离率均为第2位,其对阿米卡星、妥布霉素的耐药性呈上升趋势,差异有统计学意义(P<0.05),对其余药物3年间耐药率的差异无统计学意义(P>0.05)。结论医院获得性铜绿假单胞菌感染主要分布于侵入性操作多、抗菌药物应用广、住院周期长的临床科室,以呼吸道感染为主,3年间对抗菌药物的耐药趋势并没有明显下降,应加强抗菌药物的分级管理和耐药性监测,指导临床合理使用抗菌药物。

Objective To order to provide reference for clinical rational use of antibacterial agents, we investigated the distribution and drug resistance ofPsedornonas aeruginosain in our hospital. Methods A retrospective study by the software WHONET 5 .6 and SPSS16 .0 was conducted on 474 strains ofP . aeruginosa isolated from the clinical specimens collected from inpatients 2014 and 2016.The BioMerieux VITEK - 2 compact system was used to identify bacterial and sensitivity test . Results Totally 2407 strains of grain-negative bacteria were detected from the clinical specimens, including 474 strains ofP .aeruginosa with the detection rate of i9.7%. The common types of specimens were sputum （76.4%） , secretions （7.6%） . P .aeruginosa causing hospital-acquired infections were found frequently in intensive care unit （21.5%） and the department of respiration medicine （18.3%） ;During the past three years, the isolation rate of Pseudomonas aeruginosa was always in the second place, the drug resistance rates to TriInethoprim/sulfamethoxazole, amikacin, tobramycin were significantly increased （P〈0.05） .Conclusions Hospital-acquired infections with P .aeruginosa distributed in the departments of multi-invasive operations, widely use of antibiotics and long periods of hospitalization .Respiratory tract infection was prevalent, during the past three years, drug resistance of Psedomonas aeruginosa without significant descending trend. Therefore, bacterial resistance surveillance should be enhanced in order to provide the reference for clinical rational application.