2016—2018年某三甲医院碳青霉烯类非敏感铜绿假单胞菌的临床分布及耐药性变迁

Clinical distribution and drug resistance tendency of carbapenem-non-susceptible of Pseudomonas aeruginosa in a tertiary hospital from 2016 to 2018

目的 了解内蒙古鄂尔多斯市某三甲医院铜绿假单胞菌(Pseudomonas aeruginosa, PA)临床分离株的分布,碳青霉烯类非敏感铜绿假单胞菌(carbapenem-non-susceptible of Pseudomonas aeruginosa, CnSPA)流行情况,及PA耐药性的变迁,为抗菌药物合理应用提供依据。方法 收集2016—2018年临床科室培养标本中分离CnSPA的标本信息及其药敏数据,分析CnSPA的标本、科室来源,以及与患者年龄、性别间的关系,并计算CnSPA/PA的构成比。结果 3年间共分离PA 179株,分离株数呈逐年递增趋势;PA菌株主要分离自痰(73.2%),其次为尿(6.7%)和创面分泌物(6.7%)。共分离CnSPA 73株,分离株数呈逐年递增趋势;CnSPA菌株主要分离自痰(86.3%),创面分泌物(6.8%)。CnSPA最常见于外科(占32.9%),而CnSPA/PA的构成比ICU居于首位(87.5%)。CnSPA多分离于61~70岁年龄段人群,以男性为主。PA菌株中CnSPA构成比呈逐年升高的趋势,亚胺培南和美罗培南耐药率也呈逐年升高趋势。其他常用抗菌药物均有耐药率下降趋势,其中阿米卡星和哌拉西林/他唑巴坦耐药率最低。结论 该院CnSPA分离率较高,主要分离自痰标本、外科、老年男性患者,ICU的CnSPA/PA的构成比居于首位,应针对不同科室及人群加强医院感染防控措施,强化碳青霉烯类药物临床合理使用,预防和控制CnSPA的产生和传播。

Objective To understand the distribution of clinical isolates of Pseudomonas aeruginosa(PA), drug resistance and prevalence of carbapenem-non-susceptible PA(CnSPA) in a tertiary first-class hospital in Ordos Inner Mongolia, and the change of drug resistance of PA, so as to provide evidence for rational use of antimicrobial agents.Methods Specimen information and antimicrobial susceptibility data of CnSPA isolated from cultured specimens of clinical departments from 2016 to 2018 were collected, sources of specimens and department of CnSPA, relationship between CnSPA and age as well as sex of patients were analyzed, and isolation rates of CnSPA/PA were calculated.Results A total of 179 PA strains were isolated in the past three years, and the number of isolated PA increased year by year. Strains were mainly isolated from sputum(73.2%), followed by urine(6.7%) and wound secretion(6.7%). A total of 73 CnSPA strains were isolated in the past three years, the number of isolated CnSPA increased year by year.Strains were mainly isolated from sputum(86.3%), followed by wound secretion(6.8%). CnSPA was most common in the department of surgery(32.9%), while CnSPA/PA was the highest in ICU(87.5%). CnSPA was mostly isolated from 61~70-year-old people and mainly male. Among PA strains, the percentage of CnSPA showed an increasing trend year by year, as well as the resistance rate of Imipenem and Meropenem. The resistance rates of other antibiotics showed an reducing trend year by year, among which amikacin and piperacillin-tazobactam had the lowest resistance rates.Conclusion The isolation rate of CnSPA in this hospital was high, strains were mainly from sputum, the department of surgery and old men. CnSPA/PA was the highest in ICU. Prevention and control measures of hospital infections should be strengthened according to departments and populations, and management of clinical use of carbapenem antimicrobial agents should be strengthened to prevent and control the occurrence and prevalence of CnSPA.