中国西部地区耐亚胺培南铜绿假单胞菌的分布及耐药特点

Drug resistance and distribution characteristics of imipenem-resistant Pseudomonas aeruginosa in Western China

目的探讨中国西部地区耐亚胺培南铜绿假单胞菌的分布及耐药特点,为预防和控制医院感染,合理使用抗菌药物提供依据。方法回顾性分析2016—2017年,中国西部地区10家三甲医院微生物实验室从临床标本中分离到的耐亚胺培南铜绿假单胞菌分布及耐药性特点;数据统计及药敏分析采用WHONET 5.6软件。结果 2016—2017年共分离到铜绿假胞菌7676株,其中耐亚胺培南铜绿假单胞菌1463株(19.1%)。耐亚胺培南铜绿假单胞菌主要分离自痰液标本,2016年和2017年分别占72.4%和74.8%,其次为尿液和分泌物。科室分布以重症监护室为主,2016年和2017年分别占17.6%和18.1%,其次是神经外科和呼吸科。年龄分布特征,61～70岁的患者人数最多,共303例(占20.7%),10岁及以下的患者人数最少,共36例(占2.5%)。耐药分析结果显示,中国西部地区耐亚胺培南铜绿假单胞菌对阿米卡星耐药率较低,2016年和2017年分别为16.3%和25.7%,对左氧氟沙星耐药率较高,分别为43.4%和45.5%;对临床常用的抗菌药物的耐药性,2017年均高于2016年。结论中国西部地区耐亚胺培南铜绿假单胞菌主要分离自痰液标本,61～70岁的中老龄患者分离率较高,目前耐药形势严峻,对临床常用抗菌药物的耐药性呈上升趋势,医院应加强抗菌药物的管理和对耐亚胺培南铜绿假单胞菌感染病例的实时监控,减少此类耐药菌在医院内传播。

Objective To study the resistance and distribution of imipenem-resistant Pseudomonas aeruginosa in Western China. Methods A retrospective survey and statistics were carried out on 1459 strains of imipenem -resistant Pseudomonas aeruginosa infections and drug resistance rates from 2016 to 2017, and the WHONET 5.6 software was used to perform statistical analysis on drug susceptibility results. Results From 2016 to 2017, 7676 strains of Pseudomonas aeruginosa were isolated, of which 1,463 strains were resistant to imipenem （19.1%）. Imipenem-resistant Pseudomonas aeruginosa was mainly isolated from sputum specimens, accounting for 72.4% and 74.8% in 2016 and 2017, respectively, followed by urine and secretions. The distribution of departments was mainly intensive care units, accounting for 17.6% and 18.1% in 2016 and 2017, respectively, followed by neurosurgery and respiratory departments. As for the characteristics of the age distribution, the number of patients aged 61-70 years was the highest, with a total of 303 cases （20.7%）, which was significantly more than other age groups. The number of patients aged 10 and under was the lowest, with a total of 36 cases （2.5%）. The antimicrobial resistance of 1,463 imipenem-resistant Pseudomonas aeruginosa to 10 commonly used antimicrobial agents was counted. In 2016 and 2017, the resistance rate to amikacin was relatively low, which was 16.3% and 25.7%, respectively, followed by tobramycin, gentamicin, piperacillin/tazobactam, and ciprofioxacin. The resistance rate to levofloxacin was higher, which was 43.4% and 45.5%, respectively. Drug resistance rates to commonly used antibiotics in 2018 were higher than those in 2016. Conclusion Imipenem-resistant Pseudomonas aeruginosa was more common in sputum, and the isolation rates of the middle-aged and older patients aged 61-70 years were high. The current situation of drug resistance is severe. Clinical use should be rationally administered under the guidance of antibiotic susceptibility results. Hospitals should strengthen the management of antibiotics and real-time monitoring of carbapenem-resistant Pseudomonas aeruginosa infections, and in order to reduce the spread of such drug-resistant bacteria in hospitals.