某院91例下呼吸道铜绿假单胞菌感染患者病例分析及耐药性变化

Analysis of 91 cases infected with Pseudomonas aeruginosa at lower respiratory tract in a hospital and changes in antimicrobial resistance

目的调查住院患者下呼吸道铜绿假单胞菌(PA)感染现状、临床用药情况及PA耐药性,为临床治疗提供参考依据。方法回顾性收集某院2021年1月—2022年11月下呼吸道PA感染住院患者的病历资料,统计分析患者的基本特征、感染情况、治疗科室、感染部位、临床用药和药敏结果等相关信息。结果共选取91例患者,其中≥80岁的患者64例(70.33%),72例(79.12%)发生医院感染。除PA外,送检标本同时检出最多的菌株是肺炎克雷伯菌(17.98%),其次为鲍曼不动杆菌(16.23%)和草绿色链球菌(14.47%)。治疗下呼吸道PA感染,应用频次最高的为头孢哌酮/舒巴坦、哌拉西林/他唑巴坦及美罗培南,分别占67.03%、58.24%、58.24%。使用亚胺培南和美罗培南后,PA对两者的耐药率分别由32.69%、40.38%上升至69.23%、63.46%。结论持续使用抗菌药物与PA耐药性迅速产生相关,根据患者临床指征及药敏检验结果适时调整治疗方案尤为重要。

Objective To investigate the current status,clinical antimicrobial use,and antimicrobial resistance of hospitalized patients due to lower respiratory tract(LRT)infection with Pseudomonas aeruginosa(PA),so as to provide reference for clinical treatment.Methods Medical records of hospitalized patients with LRT PA infection from January 2021 to November 2022 in a hospital were collected retrospectively.Basic characteristics,infection status,treatment department,infection site,clinical medication,and antimicrobial susceptibility test results of patients were analyzed statistically.Results A total of 91 patients were selected,out of which 64 patients(70.33%)were≥80 years old and 72(79.12%)cases had healthcare-associated infection.Besides PA,the most commonly detected strains were Klebsiella pneumoniae(17.98%),followed by Acinetobacter baumannii(16.23%)and Streptococcus viridans(14.47%).Cefoperazone/sulbactam,piperacillin/tazobactam and meropenem were the most frequently used antimicrobial agents treating LRT PA infection,accounting for 67.03%,58.24%,and 58.24%,respectively.After using imipenem and meropenem,resistance rates of PA to both antimicrobials increased from 32.69%and 40.38%to 69.23%and 63.46%,respectively.Conclusion Continuous use of antimicrobial agents is associated with the rapid development of resistance in PA.It is particularly important to adjust treatment plans timely based on patient clinical indications and antimicrobial susceptibility test results.