铜绿假单胞菌所致感染的临床分析

目的调查本院铜绿假单胞菌感染患者的临床资料、耐药状况及变化趋势,为临床合理应用抗菌药物提供科学的依据。方法回顾性分析本院803株铜绿假单胞菌感染患者基础疾病、应用抗菌药物、侵入性操作及细菌药敏耐药情况。结果 247例患者中共分离出803株铜绿假单胞菌,标本主要分离自痰液;科室分布以重症监护病房(ICU)最高,其次为老年病房、神经内科病房;患者多合并基础疾病,且患者常行吸痰、气管插管、导尿等侵入性操作;患者应用哌拉西林/他唑巴坦最多,其次为美罗培南及头孢哌酮/舒巴坦;本院铜绿假单胞菌耐药情况严重,对多粘菌素B的敏感率最高,其次为阿米卡星;多重耐药铜绿假单胞菌(MDR-PA)及泛耐药铜绿假单胞菌(PDR-PA)比率分别为88.43%和10.70%。结论铜绿假单胞菌在痰中分离最多,老年患者多见,主要集中在ICU,与患者病情重、合并较多基础疾病、接受侵入性操作有关。临床上应限制碳青霉烯类抗菌药物的使用,以减缓铜绿假单胞菌多重耐药菌株的产生。

Clinical analysis of infection caused by Pseudomonas aeruginosa

Objective To investigate clinical data,drug resistance and trends of patients infected by Pseudomonas aeruginosa in the hospital and provide a scientific basis for rational clinical use of antimicrobial drugs.Methods The underlying diseases,use of antimicrobial drugs,invasive procedures and antimicrobial susceptibility resistance of 803 Pseudomonas aeruginosa in the hospital were retrospectively analyzed.Results There were 803 Pseudomonas aeruginosa isolated from 247 cases of patients,and the specimens were mainly isolated from sputum.In departments distribution,ICU was the highest,followed by geriatric ward and the neurology ward.Patients often combined with the underlying diseases and had line suctioning,endotracheal intubation,catheterization and other invasive procedures.What the patients used most was piperacillin/cilostazol tazobactam,followed by meropenem and cefoperazone/sulbactam.Drug resistance of Pseudomonas aeruginosa was serious in the hospital,the most sensitive one was polymyxin B,followed by amikacin.The ratios of multi-drug resistant Pseudomonas aeruginosa(MDR-PA) and pan-drug resistant Pseudomonas aeruginosa(PDR-PA) were 88.43% and 10.70% respectively.Conclusion Pseudomonas aeruginosa is isolated mostly in the sputum,commonly happens to the elderly patients and mainly concentrates in the ICU,relates to the patients’ serious condition,combining with more underlying diseases,and accepting invasive procedures.Carbapenems should be limited in the clinical use of carbapenems in order to reduce multi-drug resistant Pseudomonas aeruginosa strains.