攀枝花某三甲医院铜绿假单胞菌的临床分布及对抗菌药物敏感性的变化趋势

Clinical Distribution of Pseudomonas aeruginosa and Trends of its Susceptibility to Antimicrobial Agents ina Class 3A Hospitalfrom Panzhihua

目的探讨铜绿假单胞菌(PA)的临床感染特点及耐药性变化趋势。方法收集2015年1月-2019年12月攀枝花市某三甲医院收治患者的临床标本,用全自动微生物分析仪对其进行病原菌的鉴定及抗菌药物敏感性测定(MIC法),回顾性分析不同年份PA的感染率、来源、耐药率及其变化情况。结果五年间共分离非重复PA 1495株,占病原菌总数的6.0%,占革兰阴性菌的10.4%;感染者以男性居多;以痰标本最多见(64.1%),其次为分泌物标本(18.7%);科室分布以ICU(20.3%)、神经科(16.9%)、呼吸内科和骨科(各占15.7%)、老年科(7.3%)、肿瘤科(3.7%)较多,在神经科的分离率逐年升高。铜绿假单胞菌对氨曲南、亚胺培南、头孢他啶、哌拉西林/他唑巴坦耐药率较高(分别为23.1%、13.0%、11.6%、10.9%),对其余抗生素的耐药率均小于8.0%,共检出多重耐药铜绿假单胞菌(MDR-PA)172株,占PA 的11.5%。五年间PA除对左旋氧氟沙星的耐药率有上升趋势外,对其余抗生素的耐药率总体上均呈现下降趋势,耐药率有显著变化趋势的有:妥布霉素、左旋氧氟沙星、庆大霉素、环丙沙星、头孢吡肟、哌拉西林/他唑巴坦、氨曲南(P< 0.05),其余耐药率变化无统计学意义。结论该院PA分离率较其它大部分地区低,ICU病房、神经科和呼吸内科应做为重点防控科室。PA对多数抗菌药物的耐药率呈下降趋势,治疗上可首选头孢哌酮/舒巴坦。MDR-PA的检出率逐年上升,应引起重视。

Objective To analyze the clinical characteristics of Pseudomonas aeruginosa (PA) infection and the trend of drug resistance.Methods Specimens of patients from January 2015 to December 2019 were collected and identified by automatic microbial analyzer and antimicrobial susceptibility test (MIC) was performed,the infection rate,source,drug resistance rate and changes of PA in different years were retrospectively analyzed.Results A total of 1495 non-repeat PA strains were isolated in 5 years,accounting for 6.0% of the total pathogenic bacteria and 10.4% of gram-negative bacteria,the majority of infected males;Sputum specimens were the most common (64.1%),followed by secretion specimens (18.7%).The departments were distributed in ICU (20.3%),neurology (16.9%),respiratory medicine and orthopedics (15.7% each),geriatrics (7.3%) and oncology (3.7%),with the separation rate in neurology increasing year by year.The drug resistance rates of Pseudomonas aeruginosa to aztreonam,imipenem,ceftazidime,piperacillin/tazobactam were higher (23.1%,13.0%,11.6%,10.9%,respectively),and the drug resistance rates of other antibiotics were all less than 8%.In addition to the rising trend of drug resistance to levofloxacin,the drug resistance rate of PA to other antibiotics showed a downward trend in five years,the drug resistance rates showed significant changes in tobramycin,levofloxacin,gentamicin,ciprofloxacin,cefepime,piperacillin/tazobactam,and aztreonam (P< 0.05),while the other drug resistance rates showed no statistical significance.A total of 172 strains of multidrug-resistant Pseudomonas aeruginosa (MDR-PA) were detected,accounting for 11.5% of PA.Conclusion The rate of PA separation in this hospital was lower than that in most other areas,ICU ward,neurology department and respiratory department should be taken as key prevention and control departments.The drug resistance rate of most antibacterial drugs showed a downward trend,and cefoperazone/sulbactam was the first choice for treatment.The detection rate of MDR-PA is obviously lower than that of other regions,but it has been increasing slowly in recent three years,which should be paid attention to.