天津地区某基层医院铜绿假单胞菌的5年耐药变迁

Five-year Resistance Change of Pseudomonas Aeruginosa in a Primary Hospital in Tianjin

目的观察天津地区某基层医院铜绿假单胞菌的临床分布及其耐药情况和近5年的耐药变化趋势,为临床抗感染治疗的经验用药和合理使用抗生素提供理论依据。方法收集2013年1月～2017年12月我院住院患者细菌培养标本分离的铜绿假单胞菌,分析其科室分布及菌株对临床常用抗菌药物的耐药率和耐药变迁。结果 5年内共分离到铜绿假单胞菌542株,其分布主要以呼吸内科、ICU以及普通外科为主。铜绿假单胞菌对氨曲南、左氧氟沙星、头孢他啶、亚胺培南、美罗培南、哌拉西林他唑巴坦、阿米卡星的耐药率分别为28.80%、17.30%、15.40%、13.30%、15.30%、8.30%、3.60%。结论铜绿假单胞菌是基层三级综合医院临床科室最常见的革兰阴性非发酵菌,分离人群主要以呼吸内科、ICU和普通外科为主。我院分离的铜绿假单胞菌对大多数临床常用抗菌药物均有较好的体外敏感性。因此,临床使用这些药物治疗铜绿假单胞菌感染通常可获得良好的疗效。但由于该细菌易产生获得性耐药,且近年来少数抗菌药物的耐药率波动范围较大。因此建议临床医生关注实验室药敏结果报告和细菌耐药监测报告。

Objective To observe the clinical distribution and drug resistance of Pseudomonas aeruginosa in a primary hospital in Tianjin and the trend of drug resistance in the past five years, and provide a theoretical basis for the clinical application of anti-infective treatment and rational use of antibiotics. Methods Pseudomonas aeruginosa isolated from bacterial culture specimens from hospitalized patients in our hospital from January 2013 to December 2017 was collected. The distribution of the department and the resistance rate and resistance of the strains to clinically used antibiotics were analyzed. Results A total of 542 Pseudomonas aeruginosa strains were isolated within 5 years. The distribution was mainly in respiratory medicine, ICU and general surgery. The resistance rates of Pseudomonas aeruginosa to aztreonam, levofloxacin, ceftazidime, imipenem, meropenem, piperacillin tazobactam, and amikacin were 28.80%, 17.30%, 15.40%, and 13.30,15.30%, 8.30%, 3.60%. Conclusion Pseudomonas aeruginosa is the most common gram-negative non-fermentative bacteria in clinical departments of primary general hospitals. Respiratory medicine, ICU and general surgery are the main isolated population. Pseudomonas aeruginosa isolated from our hospital has a good in vitro sensitivity to most antibiotics commonly used in clinic. Therefore, clinical use of these drugs in the treatment of Pseudomonas aeruginosa infection can usually achieve good results. However, it is easy to develop acquired drug resistance, and the resistance rate of a few antibiotics fluctuates greatly in recent years. Therefore, it is suggested that clinicians should pay attention to the results of drug sensitivity in laboratory and the monitoring report of bacterial resistance.