奇异变形杆菌的临床分布以及耐药性分析

Clinical distribution of Proteus mirabilis and analysis of its drug resistance

目的分析杭州某医院100例奇异变形杆菌的临床分布以及药敏情况,为临床提供用药参考依据。方法收集杭州市中医院2019年1月—2021年12月来院就诊患者各种标本分离出的100例奇异变形杆菌,统计标本类型、科室分布、基础疾病、医疗干预以及药敏结果。结果奇异变形杆菌主要来源于尿液(47%),其次是痰液(12%);科室分布以泌尿科为主(24%),其次是老年病科(14%);多数患者伴随基础疾病,接受过侵入性医疗操作。敏感率>80%的抗菌药有阿米卡星、哌拉西林/他唑巴坦、厄他培南、头孢替坦、头孢吡肟、头孢他啶和氨曲南。而对呋喃妥因、氨苄西林、复方新诺明和头孢唑林耐药率>50%。结论奇异变形杆菌最常引起泌尿道感染,临床应重视医疗卫生规范,用药建议优先考虑β-内酰胺酶抑制剂复合剂哌拉西林/他唑巴坦和碳青霉烯类药物厄他培南;使用阿米卡星作为抗菌药时要密切关注患者耳毒性和肾毒性;三代、四代头孢药物也可作为用药优先考虑范畴,不建议再使用一代头孢药物头孢唑林。

Objective This paper aims to analyze the clinical distribution and drug susceptibility results of 100 cases of Proteus mirabilis in a hospital in Hangzhou,so as to provide reference for clinical medication.Methods A total of 100 cases of Proteus mirabilis were isolated from various specimens of patients to statistically collect the information of department distribution,underlying diseases,medical interventions and drug susceptibility results.Results Proteus mirabilis is mainly derived from urine(47%),followed by sputum(12%);department distribution is led by Department of Urology(24%),followed by Department of Geriatrics(14%).Most patients underwent invasive medical procedures with underlying diseases such as hypertension,urinary system,and respiratory system.Antimicrobials with sensitivity greater than 80%include amikacin,piperacillin/tazobactam,ertapenem,cefotetan,cefepime,ceftazidime,and aztreonam.The rate of resistance to nitrofurantoin,ampicillin,compound sulfamethoxazole and cefazolin is greater than 50%.Conclusion Proteus mirabilis most commonly causes urinary tract infections,clinical attention should be paid to medical and health norms,and the use of drugs should be given priority to piperacillin/tazobactam and ertapenem;when using amikacin as an antibacterial agent,close attention should be paid to patients’ototoxicity and nephrotoxicity.The third and fourth-generation cephalosporins can be given priority in clinical use,but it is not recommended to use the first generation of cefazolin.