132例铜绿假单胞菌血流感染患者的临床特征及菌株耐药性分析

目的探讨铜绿假单胞菌血流感染患者的临床特点及菌株的耐药特点。方法回顾性分析温州医科大学附属第一医院2013年1月-2017年12月铜绿假单胞菌血流感染患者的临床及微生物学资料。结果132例铜绿假单胞菌血流感染患者纳入研究,发生血流感染时均有发热、外周血白细胞减少或升高;28例患者病情继续恶化或住院死亡,占21.21%;多重耐药菌株(MDR)感染24例,占18.18%。血液分离的铜绿假单胞菌对阿米卡星的耐药率最低,为3.79%(5/132);对亚胺培南的耐药率最高,为28.03%(37/132)。与2013年-2015年分离菌株相比,2016年-2017年分离菌株对阿米卡星、环丙沙星、哌拉西林/他唑巴坦、妥布霉素与庆大霉素的耐药率显著降低(P<0.05)。与非MDR组相比,MDR组白细胞高、血培养阳性报警时间长、侵入性治疗比例高、预后差,差异均有统计学意义(P<0.05)。结论铜绿假单胞菌血流感染患者病情较重,必须加强耐药性监测,合理使用抗菌药物。

Clinical characteristics and drug resistance analysis of 132 patients with bloodstream infection by Pseudomonas aeruginosa

Objective To investigate the clinical characteristics of patients with bloodstream infection caused by Pseudomonas aeruginosa and the resistance of Pseudomonas aeruginosa isolates to antimicrobial agents.Methods The clinical data of patients infected with P.aeruginosa from January 2013 to December 2017 in the First Affiliated Hospital of Wenzhou Medical University were reviewed.Results A total of 132 patients were found with P.aeruginosa bloodstream infection.All patients had fever and increased or decreased white blood cell when their bloodstream infection was identified.Twenty-eight patients(21.21%)worsened or died in hospitalization,while twenty-four patients(18.18%)were infected by multi-drug resistant strains(MDR).The resistance rate of P.aeruginosa to amikacin was the lowest(3.79%),and the resistance rate to imipenem was the highest(28.03%).The resistance rates of the Pseudomonas aeruginosa isolated during 2016-2017 to amikacin,ciprofloxacin,piperacillin/tazobactam,tobramycin,and gentamicin were significantly lower those that during 2013-2015(P<0.05).Compared with the non-MDR group,the MDR group has the following characteristics:high white blood cells,long time to positiveness of blood cultures,high incidence of invasive treatment,and poor prognosis,with the above differences statistically significant(P<0.05).Conclusion Patients with P.aeruginosa bloodstream infections are severely ill,so it is necessary to monitor drug resistance and use antimicrobial drugs rationally.