2014～2017年某院临床分离铜绿假单胞菌耐药趋势分析

The Isolation Rate of Pseudomonas Aeruginosaand Drug Resistance Analysis from 2014 to 2017 in Hospital

目的分析临床分离铜绿假单胞菌对各抗菌药物的耐药趋势,为临床合理使用抗菌药物提供依据。方法采用微量稀释法对2014～2017年某院临床分离的1 966株铜绿假单胞菌药物敏感性进行检测,用卡方检验法进行年间和品种间的差异分析,通过Cox-Staurt趋势检验法通过季度数据检验碳青霉烯的耐药倾向; Pearson相关性分析法,分析耐碳青霉烯类铜绿假单胞菌耐药趋势与该类药物使用强度的相关性。结果该院2014～2017年铜绿假单胞菌总检出率11.0%,位居革兰氏阴性菌第二,检出科室以神经外科、呼吸内科、ICU为主。多重耐药铜绿假单胞菌检出率8.5%,耐碳青霉烯类铜绿假单胞菌检出率29.1%。药敏试验结果显示铜绿假单胞菌对阿米卡星耐药率最低(13.5%);对头孢他啶、头孢吡肟耐药率分别由35.1%、31.1%降至为21.1%、19.6%,而哌拉西林/他唑巴坦则表现出较低耐药率(20.7%);但对氟喹诺酮类耐药率偏高,处在30%左右耐药率水平。对碳青霉烯类的耐药率4年间居高不下,呈上升趋势,平均耐药率亚胺培南为33.5%,美罗培南为28.6%,进一步分析与同时用药相关度分别为-9.36%、14.63%。结论该院铜绿假单胞菌耐药问题较严重,应进一步对铜绿假单胞菌高检出率科室进行耐药监测,并加强临床抗菌药物应用的管理。

OBJECTIVE To investigate the changes of isolation rate and drug resistance of pseudomonas aeruginosa in a hospital,so as to provide reference for reasonable selection of antimicrobials. METHODS 1 966 Strains clinical isolated pseudomonas aeruginosa were tested by minor dilution method.The difference among years and varieties were analyzed by Chi-Square test.Carbapenemresistance tendency was tested by Cox-Staurt trend test analysis method by quarterly data.Pearson correlation analysis was used to analyze the correlation between resistance trend and Antibiotics Use Density of carbapenems. RESULTS From 2014 to 2017,the total detection rate of pseudomonas aeruginosa was 11. 0%, ranked second in gram-negative bacteria,which distributed mainly in neurosurgery,respiratory medicine and ICU. Multidrug-resistant strains accounted for 29. 1% while carbapenem-resistant strains 8. 5%.The results of drug susceptibility testing showed that amikacin remained the lowest drug resistance rate( 13.5%).And the drug resistance rates to ceftazidime and cefepime were reduced form 35.1% and 31.1% to 21.1% and 19.6% respectively,while piperacillin/tazobactam showed a lower resistance rate( 20. 7%). But fluoroquinolones showed a higher resistance rate,which was on the level of about 30%.Pseudomonas aeruginosa showed continuously high rate of resistance to imipenem and meropenem,the four years’ average rate was33.5% and 28. 6%,and the correlation between resistance rate and the intensity of antimicrobial use was-9. 36% and 14. 63%respectively. CONCLUSION Drug-resistance problem is serious in hospital.Antibacterialagents management and usage should still be reinforced,especially in those departments with high drug-resistance rate.