普罗威登斯菌属的临床分布和耐药性

Clinical distribution and drug resistance of Providencia spp.

目的 分析普罗威登斯菌属的临床分布特点及耐药现状,为临床预防和合理抗感染治疗提供依据。方法分析2015年7月-2021年6月杭州市中医院临床分离的普罗威登斯菌属的来源及耐药性,比较不同来源分离菌株对常用抗菌药物的耐药率。结果 共分离出普罗威登斯菌属88株,雷氏普罗威登斯菌占84.1%,斯氏普罗威登斯菌占15.9%;科室分布以重症监护室为主,占28.4%,其次是急诊内科、老年病科和神经内科;临床标本以尿液和痰液为主,分别占51.1%和36.4%。普罗威登斯菌属对阿米卡星、氨曲南和头孢吡肟、哌拉西林/他唑巴坦、头孢曲松和厄他培南的敏感性较高,而对氨苄西林/舒巴坦、环丙沙星、左氧氟沙星、庆大霉素和妥布霉素的耐药率较高。尿液标本分离菌株对环丙沙星、左氧氟沙星的耐药率高于其他标本分离株(P<0.05),而对庆大霉素、妥布霉素、甲氧苄啶/磺胺甲恶唑的耐药率低于其他标本分离株(P<0.05)。结论 对普罗威登斯菌属所致感染应引起重视,并合理使用抗菌药物早期治疗,临床治疗可优先考虑头孢吡肟、氨曲南和阿米卡星,还需结合不同感染部位选用不同抗菌药物,以提高治疗效果。

OBJECTIVE To investigate the clinical distribution and drug resistance of Providencia spp. so as to provide guidance for clinical prevention and reasonable treatment of infection. METHODS The sources and drug resistance of the clinical Providencia spp. isolates that were isolated from Hangzhou Hospital of Traditional Chinese Medicine between Jul 2015 and Jun 2021 were investigated, and the drug resistance rates to the commonly used antibiotics were observed and compared among the strains that were isolated from different specimen sources. RESULTS Totally 88 strains of Providencia spp. were isolated, 84.1% of which were Providencia rettgeri, and 15.9% were Providencia stuartii. 28.4% of the strains were isolated from intensive care unit, followed by emergency internal medicine department, geriatric department and neurology department. Among the clinical specimens where the strains were isolated, 51.1% were isolated from urine specimens, and 36.4% were isolated from sputum specimens. The Providencia spp. strains were highly sensitive to amikacin, aztreonam, cefepime, piperacillin-tazobactam, ceftriaxone and ertapenem, but the strains were highly resistant to ampicillin-sulbactam, ciprofloxacin, levofloxacin, gentamycin and tobramycin. The drug resistance rates of the strains isolated from urine specimens to ciprofloxacin and levofloxacin were significantly higher than those of the strains isolated from other specimens(P<0.05), however, the drug resistance rates of the strains isolated from urine specimens to gentamycin, tobramycin and trimethoprim-sulfamethoxazole were significantly lower than those of the strains isolated from other specimens(P<0.05). CONCLUSION It is necessary to attach great importance to the infection caused by the Providencia spp. and reasonably use antibiotics for early treatment. Cefepime, aztreonam and amikacin should be the first choice for clinical treatment, and the antibiotics should be used based on the site of infection so as to improve the therapeutic effect.