铜绿假单胞菌临床分布及耐药性的不均一性

目的了解住院患者分离的铜绿假单胞菌临床分布及耐药特点,为临床经验使用抗菌药物及医院感染控制提供参考。方法回顾性分析某院2012—2016年住院患者检出的铜绿假单胞菌的临床分布及药敏结果,按不同病区、标本类型和年龄分组进行统计分析。结果 2012—2016年共分离铜绿假单胞菌2 432株,主要科室来源为重症监护病房(727株,29.89%),主要标本来源为痰(2 064株,84.87%)。2012—2016年各年份铜绿假单胞菌对除哌拉西林/他唑巴坦外的其他抗菌药物的耐药率比较,差异均有统计学意义(均P0.05)。对哌拉西林、头孢他啶、头孢吡肟、亚胺培南、美罗培南、左氧氟沙星、环丙沙星的耐药性在2014年达高峰后有下降趋势;对阿米卡星、庆大霉素、妥布霉素的耐药率较低,且呈逐年下降趋势(均P0.05)。除头孢吡肟和妥布霉素外,来源于痰标本的铜绿假单胞菌对抗菌药物的耐药率均高于其他标本(均P0.05)。≥65岁患者分离的菌株对大多数抗菌药物的耐药率高于65岁患者(均P0.05)。除庆大霉素、妥布霉素外,ICU分离的铜绿假单胞菌对抗菌药物的耐药率均高于其他科室,为7.71%~66.02%。外科分离的铜绿假单胞菌对常用抗菌药物的耐药率相对较低,为1.69%~11.86%。结论铜绿假单胞菌耐药性在临床分布呈明显不均一性,抗菌药物的经验用药以及医院感染监控措施的制定应参考不同病区、不同感染部位和不同年龄的耐药监测数据。

Clinical distribution and heterogeneity of antimicrobial resistance of Pseudomonas aeruginosa

ObjectiveTo understand clinical distribution and antimicrobial resistance characteristics of Pseudomonas aeruginosa(P. aeruginosa) isolated from hospitalized patients, so as to provide reference for the empiric use of antimicrobial agents and control of healthcare associated infection(HAI). MethodsClinical distribution and antimicrobial susceptibility testing results of P. aeruginosa isolated from patients in a hospital between 2012 and 2016 were analyzed retrospectively, statistical analysis were conducted based on different wards, specimen types and age groups. ResultsA total of 2 432 strains of P. aeruginosa were isolated from 2012 to 2016, most of which were isolated from intensive care unit(ICU) (n=727, 29.89%), the main specimen was sputum(n=2 064，84.87%）. Resistance rates of P. aeruginosa to other antimicrobial agents except piperacillin/tazobactam in each year from 2012 to 2016 were significantly different(all P<0.05). Resistance to piperacillin, ceftazidime, cefepime, imipenem, meropenem, levofloxacin, and ciprofloxacin decreased after peaked in 2014; resistance rates to amikacin, gentamicin, and tobramycin were all low, showing decreased trend year by year(all P<0.05). Except resistance rates to cefepime and tobramycin, resistance rates of P. aeruginosa from sputum specimen were all higher than other specimens(all P<0.05). Resistance rates of P. aeruginosa isolated from patients aged≥65 years to most antimicrobial agents were significantly higher than those isolated from patients aged＜65 years(all P<0.05). Except resistance rates to gentamicin and tobramycin, resistance rates of P. aeruginosa isolated from ICU were higher than those isolated from other departments, which were 7.71%-66.02%. Resistance rate of P. aeruginosa isolated from department of surgery were relatively low, which were 1.69%-11.86%. ConclusionClinical distribution of antimicrobial resistance of P. aeruginosa is obviously heterogeneity, empiric antimicrobial use and formulation of HAI monitoring measures should be based on the data of antimicrobial resistance in different wards, different infection sites, and different age.