2002-2010年医院临床分离铜绿假单胞菌的分布特征及耐药谱变迁

目的 了解2002-2010年铜绿假单胞菌的分布特征及耐药性变迁,为临床治疗提供参考.方法 回顾性分析2002-2010年湖州市中心医院各类临床标本分离出的铜绿假单胞菌的检出率、分布特点及药敏结果.结果 9年共检出铜绿假单胞菌4423株,分离率为9.2％;标本来源以痰液为主,占68.6％,其次是脓液及分泌物,占16.4％;科室分布以重症监护病房最多,占29.9％,其次是呼吸内科和脑外科,分别占19.8％和16.8％;铜绿假单胞菌对氨苄西林/舒巴坦和磺胺甲噁唑/甲氧苄啶完全耐药,对替卡西林、替卡西林/克拉维酸、哌拉西林的耐药性较严重,呈逐年上升态势,其总体耐药率为70.3％、67.4％、70.0％;对哌拉西林/他唑巴坦、头孢他啶、头孢吡肟、妥布霉素、庆大霉素、环丙沙星的耐药率在2002-2008年也均呈逐年上升态势,但2009年后均有所下降,尤其以2010年下降明显,其总体耐药率为分别为48.1％、52.2％、51.7％、57.2％、56.0％、59.0％;对亚胺培南和美罗培南2005年以前具有良好的敏感性,但2006年耐药性迅速上升,2008年达到66.2％和55.3％,2009年后又明显下降;对头孢哌酮/舒巴坦、阿米卡星和多黏菌素E9年间均保持较好的敏感性.结论 铜绿假单胞菌的分离率和耐药性呈上升趋势,应加强抗菌药物分级管理,依据药敏结果合理选用抗菌药物,同时做好医院感染控制,防止耐药菌株的播散.

Distribution and drug resistance of Pseudomonas aeruginosa isolated from clinical specimens 2002 to 2010

OBJECTIVE To investigate the characteristics of distribution and the change of drug resistance of Pseudomonas aeruginosa from 2002 to 2010,so as to provide reference for clinical treatment.METHODS The isolation rate,distribution and drug resistance of P.aeruginosa isolated from various clinical specimens from Huzhou Central Hospital from 2002 to 2010 were retrospectively analyzed.RESULTS A total of 4423 strains of P.aeruginosa were isolated during the past nine years,the isolation rate was 9.2%.Sputum was the main source of infection from which 68.6% strains of P.aeruginosa were isolated.P.aeruginosa were mainly distributed in ICU wards(29.9%),pneumology department(19.8%) and neurosurgery department(16.8%).The result of drug susceptibility testing showed that the resistance rates to compound ampicillin and compound sulfamethoxazole were all 100.0%.The resistance rates to ticarcillin,ticarcillin/clavulanic acid,and piperacillin were 70.3%,67.4%,70.0%,respectively;the resistance rates to piperacillin/tazobactam,ceftazidime,cefepime,tobramycin,gentamicin,and ciprofloxacin showed an increasing trend from 2002 to 2008,but in 2009,the resistance rates began to decline and a significant decrease was presented in 2010,and total resistance rates were 48.1%,52.2%,51.7%,57.2%,56.0% and 59.0%,respectively.The susceptibility rates to imipenem and meropenem were high before 2005,but the drug resistance increased rapidly in 2006,reaching 66.2% and 55.3% in 2008,and declined significantly in 2009.P.aeruginosa kept highly susceptibility to cefoperazone/sulbactam,amikacin and polymyxin E during the past 9 years.CONCLUSION The isolation rate and drug resistance of P.aeruginosa keep an increasing tendency.It is mandatory for hospital to strengthen antimicrobial classification management,choose the antibiotics reasonably according to the antimicrobial susceptibility testing results and strengthen the control of hospital infection,so as to prevent the spread of multidrug-resistant strains.