ICU与普通病房铜绿假单胞菌感染分布及耐药性分析

目的 对比重症临护病房(ICU)与普通病房铜绿假单胞菌(PAE)感染分布特征和耐药性,以指导临床合理用药.方法 采用法国生物梅里埃公司VITEK-32、VITEK-2 Compact全自动微生物测试仪鉴定PAE,药敏试验用K-B纸片法；抗菌药物耐药率的显著性比较用x2检验.结果 分离341株PAE主要来自痰液占62.5％；科室分布ICU最多占51.3％；秋季感染率最高为34.0％,ICU与普通病房感染PAE月份分布差异不大；ICU分离菌株对亚胺培南耐药率为27.4％、普通病房为5.4％,差异有统计学意义(P＜0.05),对阿米卡星、头孢吡肟、庆大霉素、左氧氟沙星、头孢他啶、妥布霉素、哌拉西林/他唑巴坦耐药率高于普通病房,差异有统计学意义(P＜0.05);ICU中PAE多药耐药(MDR)占53.2％、泛耐药(PDR)占18.8％；普通病房MDR占14.5％、PDR占3.6％,差异有统计学意义(P＜0.05).结论 PAE分离最主要来自痰标本,应加强病房环境的消毒,有利于降低铜绿假单胞菌感染；ICU铜绿假单胞菌耐药率显著高于普通病房；MDR和PDR分离率很高,ICU MDR＞50.0％,耐药性严重.

Distribution and drug resistance of Pseudomonas aeruginosa infections in ICU and common wards

OBJECTIVE To compare the distribution and drug resistance of Pseudomonas aeruginosa in ICU and common wards so as to guide the clinical rational use of antimicrobial drugs.METHODS The P.aeruginosa isolates were detected by VITEK-32 and VITEK-2 compact system,and antimicrobial susceptibility was tested by K-B method.The significance of the resistant rate was analyzed by χ2.RESULTS A total of 341 strains of P.aeruginosa were isolated,which were mainly from sputum(62.5%);most isolates distributed in ICU,accounting for 51.3%;the infection rate was the highest in autumn(34.0%),there was little difference in the monthly distribution of P.aeruginosa between the ICU and the common wards;the resistance rate of the isolates from ICU was 27.4%,the common wards 5.4%,the difference was statistically significant(P<0.05);the resistant rates of P.aeruginosa isolates from ICU to amikacin,cefepime,gentamicin,levofloxacin,ceftazidime,tobramycin,and piperacillin/tazobactam were higher than from the common wards,the difference was statistically significant(P<0.005);of the P.aeruginosa isolates from ICU,multidrug-resistant(MDR) and pan-drug resistant(PDR) strains accounted for 53.2% and 18.8%,respectively;of the isolates from the common wards,MDR and PDR strains accounted for 14.5% and 3.6%,the difference was statistically significant(P<0.05).CONCLUSION P.aeruginosa isolates are mainly isolated from sputum,it is necessary to strengthen the disinfections,which is conducive to the reduction of P.aeruginosa infections;the drug resistance of P.aeruginosa isolates from ICU is significantly higher than from the common wards;the isolation rates of MDR and PDR strains are so high,MDR strains from ICU is more than 50.0%,and the drug resistance is serious.