204株耐碳青霉烯铜绿假单胞菌的临床特点和耐药性分析

Clinical characteristics and antimicrobial resistance analysis of 204 strains of carbapenem resistant pseudomonas aeruginosa

目的分析204株耐碳青霉烯铜绿假单胞菌的临床分布、患者因素和耐药性,为临床合理有效使用抗菌药物提供科学依据。方法采取VITEK-2 Compact全自动微生物分析系统对2017年1月—12月我院分离的204株耐碳青霉烯铜绿假单胞菌进行鉴定及药敏试验,分析临床分布、标本来源。比较患者不同因素对耐碳青霉烯铜绿假单胞菌检出率的影响。比较呼吸道与非呼吸道分离株、ICU与普通病房分离株的耐药性差异。结果 204株耐碳青霉烯铜绿假单胞菌分布于ICU 97株、普通病房107株。标本来源以呼吸道为主,共169株,占82.84%;非呼吸道35株,占17.16%。有基础疾病、近90 d使用抗菌药物、进行侵入性操作以及菌株检出时间距入院时间>48 h的患者耐碳青霉烯铜绿假单胞菌的检出率均分别高于无基础疾病、近90 d未使用抗菌药物、未进行侵入性操作以及菌株检出时间距入院时间≤48 h的患者(P<0.01)。呼吸道标本组对头孢他啶、环丙沙星的耐药率显著低于非呼吸道标本组(P<0.05),余12种抗菌药物耐药率差异无统计学意义(P>0.05)。普通病房分离株对替卡西林/克拉维酸、头孢哌酮/舒巴坦、阿米卡星、头孢吡肟、庆大霉素耐药率显著低于ICU病房(P<0.05),余9种抗菌药物耐药率差异无统计学意义(P>0.05)。204株耐碳青霉烯铜绿假单胞菌对亚胺培南、美罗培南耐药率差异无统计学意义(P>0.05)。结论耐碳青霉烯铜绿假单胞菌感染多发生于院内,在ICU、普通病房,呼吸道、非呼吸道的耐药形势已同样严峻,应引起临床高度重视。

Objective To analyze clinical distribution, patients factors and drug resistance of 204 strains of carbapenem resistant pseudomonas aeruginosa （CRPA）, and to provide scientific basis for clinical rational and effective use of antimicrobial agents. Methods The VITEK-2 Compact automatic microbial analysis system was used for bacterial species identification and drug sensitivity test of isolated 204 strains of CRPA in our hospital from January 2017 to December 2017. The clinical distribution and specimen sources were analyzed. The influence of different factors on the detection rate of CRPA was compared between groups of patients. The differences of drug resistance of isolated strains were compared between the respiratory tract and non-respiratory tract specimens, and between intensive care unit （ICU） and ordinary ward. Results There were 97 strains of CRPA in ICU and 107 strains of CRPA in ordinary ward in total 204 strains of CRPA. The specimens were mainly from respiratory tract, accounting for 169 strains （82.84%）. The rest was from non-respiratory tract, accounting for 35 strains （17.16%）. The detection rates of CRPA were significantly higher in patients with underlying disease, use of antibacterial agents for nearly 90 days, invasive procedures, and the detection time of bacterial strains was 〉 48 hours after admission than those in patients with no underlying disease, no antibacterial drug use for nearly 90 days, no invasive operation, and the detection time of bacterial strains was ≤48 hours after admission （P 〈 0.01）. The drug resistance rates to eeftazidime and eiprofloxaein were significantly lower in the respiratory specimen group than those in the non-respiratory specimen group （P 〈 0.05）, and there were no significant differences in drug resistance rates to 12 remaining antibacterial agents between two groups of patients （P 〉 0.05）. The drug resistance rates were significantly lower in isolated strains of tieaeillin/elavie acid, eefoperazone/shubatan, amikaein, eefepime and gentamyein in the ordinary ward than those in ICU （P 〈 0.05）, and there were no significant differences in drug resistance rates of the 9 remaining antibacterial agents （P 〉 0.05）. There were no significant differences in the drug resistance rates between imipenan and meropenenl in 204 strains of CRPA （P 〉 0.05）. Conclusion The infection of CRPA occurs frequently in hospital. The drug resistance situation is equally severe in ICU and ordinary ward, and in the respiratory system and non- respiratory system. It should be caused clinical attention.