外科重症监护病房铜绿假单胞菌耐药性分析

目的了解南京军区南京总医院外科重症监护病房（ICU）标本中分离的铜绿假单胞菌的耐药情况，并与普通病房比较。方法采用K—B纸片扩散法，用8种抗菌药物对分离的786株铜绿假单胞菌进行药敏试验。结果外科ICU与普通病房铜绿假单胞菌对8种抗菌药物的耐药率，有非常显著性差异（P〈0．001）。结论外科ICU铜绿假单胞菌耐药严重，应及时进行耐药性检测，采取严格的隔离措施，防止交叉感染。     

外科重症监护病房铜绿假单胞菌耐药性分析

目的了解南京军区南京总医院外科重症监护病房(ICU)标本中分离的铜绿假单胞菌的耐药情况,并与普通病房比较。方法采用K-B纸片扩散法,用8种抗菌药物对分离的786株铜绿假单胞菌进行药敏试验。结果外科ICU与普通病房铜绿假单胞菌对8种抗菌药物的耐药率,有非常显著性差异(P<0.001)。结论外科ICU铜绿假单胞菌耐药严重,应及时进行耐药性检测,采取严格的隔离措施,防止交叉感染。     

重症监护病房多重耐药铜绿假单胞菌耐药性分析及预防策略

目的掌握我院重症监护病房多重耐药铜绿假单胞菌耐药情况,为临床合理选药和控制多重耐药菌株的产生和传播提供依据。方法对我院2010年~2013年重症监护病房检出的227株铜绿假单胞菌的耐药情况进行统计分析。结果分离的227株铜绿假单胞菌,其中检出多重耐药菌株103株,占45.37%,铜绿假单胞菌耐药情况非常严重,仅对多黏菌素E全敏,对亚胺培南和美罗培南的耐药率在25.0%左右。结论重症监护病房铜绿假单胞菌感染发生率较高,且多重耐药菌株较多,应当引起临床的高度重视,加强细菌耐药监测,减少耐药菌株的产生,控制耐药菌株的传播。     

重症监护病房患者铜绿假单胞菌IMP-1耐药基因检测及其耐药性分析

目的:探讨重症监护病房(intensive care unit,ICU)患者铜绿假单胞菌IMP-1耐药基因检测及耐药性,为临床合理使用抗生素提供依据.方法:采用聚合酶链反应(PCR)检测耐药基因IMP-1,ATB Expression自动鉴定病原菌及药敏分析.结果:2007～2009年共分离出106株铜绿假单胞菌,对头孢他啶、亚胺培南、哌拉西林、氨曲南、头孢哌酮、头孢吡肟、左氧氟沙星的耐药率分别为50.9%、39.6%、79.2%、56.6%、57.5%、41.5%、25.5%.每年耐亚胺培南株的检出率依序分别为16.0%、28.3%、39.6%.耐亚胺培南株绝大部分检出IMP耐药基因.结论:ICU患者金属酶表型阳性菌株检出的基因型主要为IMP-1,产酶菌株耐药性强,随时进行细菌耐药性监测,正确使用有效的抗生素是控制感染和延缓细菌耐药的关键.     

122例重症监护患者铜绿假单胞菌的感染分布与耐药性分析

目的：调查铜绿假单胞菌感染的分布和耐药情况。方法：采用改良Kirby Baller法对重症监护病房(ICU)122株临床分离的铜绿假单胞菌进行抗菌药物敏感性测定。结果：铜绿假单胞菌所致疾病以下呼吸道感染为主，从痰标本中分离最多。其耐药率最低的是阿米卡星(27.8%)，其次为头孢他啶(39.2%)、头孢哌酮/舒巴坦(49.2%)，其余均＞50.0%。结论：铜绿假单胞菌近年来对抗菌药物的耐药性增长很快，临床需大力推行抗菌药物的合理应用。     

重症监护病房铜绿假单胞菌耐药性分析及对策

目的:分析ICU感染的铜绿假单胞菌耐药情况.方法:收集2007.7～2008.12入住ICU患者的基本资料及各类标本,标本进行细菌培养及药敏试验,对患者耐药情况进行分析.结果:共分离出199株铜绿假单胞菌菌株,美洛培南敏感率为96.2%、阿米卡星敏感率为69.6%、头孢哌酮/舒巴坦敏感率为65.4%、哌拉西林/他唑巴坦敏感率为61.6%、亚胺培南敏感率为57.2%、头孢吡肟敏感率为32.4%、头孢他啶敏感率为28.3%;通过分析发现,住院时间长、使用抗菌药物、侵入治疗、呼吸衰竭、手术等均为铜绿假单胞菌耐药的危险因素.结论:ICU铜绿假单胞菌耐药现象已十分突出,对多重耐药菌株的感染应以预防为主,建立耐药监控体系,控制耐药的发展及扩散.     

ICU分离139株铜绿假单胞菌耐药性分析

目的了解我院重症监护病房(ICU)铜绿假单胞菌的临床分布及耐药情况,指导临床合理选择抗菌药物。方法回顾性分析2013年1月~2015年12月我院ICU临床标本分离出的铜绿假单胞菌的分布特点及药敏变化。结果 ICU共检出铜绿假单胞菌139株,来源主要为痰(85.6%)标本。铜绿假单胞菌对氨曲南(33.0%)的耐药率最高,其次为亚胺培南(22.9%),对阿米卡星(2.2%)耐药率最低。结论加强铜绿假单胞菌感染的耐药性监测,根据药敏结果合理使用抗菌药物,是控制铜绿假单胞菌感染及耐药的关键因素。     

我院ICU病房1999～2005年铜绿假单胞菌耐药性分析

目的 了解近年来我院重症监护病房（ICU）患者铜绿假单胞菌（PA）感染的临床特点及耐药趋势，分析引起ICU铜绿假单胞菌感染的原因，指导临床正确面对PA感染，合理使用抗生素。方法 做细菌培养及鉴定，并以纸片法（KB法）测定7年来333株PA对17种抗菌药的耐药率。结果 共分离鉴定铜绿假单胞菌333株，其中源于呼吸道的260株，占78．1％，居首位；老年性重症息者是PA易感人群；七年来，PA对多种抗生素的耐药率均不同程度增长。结论 铜绿假单胞菌已成为医院感染尤其是ICU感染的主要致病菌，在抗生素治疗过程中极易变异而形成多重耐药，ICU病人机体免疫力低下，是PA的易感人群及重要防治对象；PA的耐药谱较广，临床应慎重选择抗生素,ICU病房应加强消毒隔离措施，阻隔各种可能的传播媒介，避免PA的交叉感染。     

呼吸科病房铜绿假单胞菌耐药性分析

目的促进临床合理选择抗菌药物。方法采用回顾性调查方法，对该院呼吸科病房2004年1月至2006年12月铜绿假单胞菌的药物敏感试验结果与常用抗菌药物的年消耗量进行统计分析。结果3年间，该院呼吸科从临床标本中共分离细菌1048株，其中铜绿假单胞菌208株，分离率最高（19．85％）；铜绿假单胞菌对左氧氟沙星、头孢哌酮舒巴坦钠、亚胺培南等的耐药性3年间均有不同程度地增加，头孢他啶、阿米卡星对铜绿假单胞菌仍有较好的抗菌活性，头孢吡肟保持着较高的敏感率。结论铜绿假单胞菌对消耗量大的抗菌药物耐药率高且多重耐药菌较普遍。根据药物敏感试验结果合理使用抗菌药物，对减缓细菌耐药性的增长非常重要。     

护理干预在预防重症监护病房患者铜绿假单胞菌感染中的应用

目的探讨护理干预在预防重症监护病房患者铜绿假单胞菌感染中的应用效果。方法选择2009年1月至2010年12月我院重症监护病房80例患者作为对照组,2011年1月至2012年12月我院重症监护病房入住的80例患者作为观察组。对照组患者实施常规护理,观察组患者给予预防性护理,观察两组患者铜绿假单胞菌感染率和患者满意度。结果观察组患者铜绿假单胞菌感染感染率明显低于对照组,患者满意度明显优于对照组,差异均有统计学意义。结论在重症监护病房内给予预防性护理可以有效减少铜绿假单胞菌的感染,提高患者满意度。     

ICU病房29株铜绿假单胞菌的耐药表型及基因型分析

目的探讨ICU铜绿假单胞菌(PA)耐药表型及基因型特征。方法采用K-B法测定29株PA对15种抗生素的药敏结果。用PCR检测21种耐药基因,分析从ICU分离的29株PA的耐药表型及其基因型。结果 29株PA对15种抗生素的耐药率都较高。其中,对比阿培南、左氧氟沙星、环丙沙星的耐药率分别为27.59%、51.72%、55.17%,对其他常用抗生素的耐药率均在60.00%以上。29株PA耐药基因阳性率较高的有aac(6′)-Ⅱ、ant(3″)-Ⅰ、qacE△1-sul1及intⅠ1,阳性率分别为79.31%、72.41%、75.86%及51.72%。结论该组PA携带多种耐药基因;其耐药主要与Ⅰ类整合子、aac(6′)-Ⅱ、ant(3″)-Ⅰ有关。     

Characteristics of Pseudomonas aeruginosa isolates from intensive care unit

The study looked at the antimicrobial resistance patterns, serotypes, molecular types, metallo beta-lactamase, and chromosomal betalactamase enzymes of P. aeruginosa strains isolated from the patients and the staffs of the intensive care unit. P. aeruginosa isolates from the patients as nosocomial pathogens and from the staffs were evaluated for their susceptibilities to the antimicrobials by the disk diffusion and E-test methods. Metallo beta-lactamase enzymes were investigated by E-test, the inducibility of β - lactamase enzymes were detected by the disk antagonism test. Serotyping was performed by slide agglutination method. The P. aeruginosa isolates were typed by pulsed field gel electrophoresis. Twenty-five P. aeruginosa strains from the patients and three from the staffs were isolated. Fifteen P. aeruginosa, eleven of which composed of MDR bacteria, were found in serogroup E, 7 strains in G, 4 strains in B, and 1 strain in serogroup A. In all 12 bacteria in the MDR and serogroup E, metallo beta-lactamase enzyme was found to be positive. And in other 15 strains, except the bacterium which could not be serotyped, chromosomal beta-lactamase was found to be positive. The result of the molecular typing showed PFGE A pattern. In conclusion, a pattern in PFGE which included bacteria from MDR and serogroup E, G which was observed in the P. aeruginosa strains which was isolated from the staff’s hands and from the 5 patients, and PFGE F pattern were found to be observed the most. Finally, the two different clonal strains were found to be established in the intensive care.     

Efflux pump genes and antimicrobial resistance of Pseudomonas aeruginosa strains isolated from lower respiratory tract infections acquired in an intensive care unit

The aim of this study was to determine the antimicrobial resistance rates and the resistance genes associated with efflux pumps of Pseudomonas aeruginosa strains isolated from the patients who acquired lower respiratory tract infection (LRTI) in intensive care unit (ICU). Fifty P. aeruginosa strains isolated from the lower respiratory tract specimens of the patients who acquired LRTIs in ICU were included in this study. P. aeruginosa strains were isolated from tracheal aspirate (27), bronchoalveolar lavage (14) and sputum (9). The susceptibilities of the isolates were investigated by the disk diffusion method. Multiplex PCR assay was carried out for the detection of 13 antibiotic-resistance genes. Antimicrobial resistance rates of the isolates were found high and the highest resistance rate of the isolates studied was determined against to mezlocillin (50%) followed by norfloxacin (48%), ciprofloxacin (46%), meropenem (40%). Fourty-three isolates (86%) were determined to carry one and more resistance genes. NfxB gene was most often determined in the genes that were investigated. The significant relation between the resistance to cefepime, piperacilline/tazobactam and the mexC gene, that between the resistance to mezlocillin, piperacilline/tazobactam, ceftazidime, cefepime and ampC genes, and that between the resistance to ciprofloxacin, norfloxacin and oprJ, oprN and nfxB genes was identified. Resistance caused by genes for carbapenemases, aminoglycoside-modifying enzymes and other mechanisms were not identified in this study. Understanding the prevalence and mechanism of antimicrobial resistance in P. aeruginosa may help to select empirical therapy for nosocomial LRTIs due to P. aeruginosa in our ICU.     

Fatal multi-resistant Pseudomonas aeruginosa septicemia outbreak in a neonatal intensive care unit in Trinidad

Between July 2-3, 1998, six infants on the neonatal intensive care unit (ICU) at San Fernando General Hospital died following septicemia with multi-resistant Pseudomonas aeruginosa. All patients were infected with the same strain and all were resistant to gentamicin, tobramycin, piperacillin and ceftazidime. Samples of hand washing liquids from the hands of the neonatal ICU staff were cultured and no P. aeruginosa was detected. Patients' environment and environmental surfaces: latches and interiors of incubators, sink traps and the operating theater environment and suction tubing were cultured, and P. aeruginosa with the same antibiogram was recovered from the suction tubing and the sink trap of the only tap on the neonatal ICU. Following the intervention of the infection control team and their strong re-emphasis on compliance with proper hand washing procedures and sterilization techniques, no cluster of infection with this strain or any other strain of P. aeruginosa were subsequently observed. The infecting strain may have been transferred from the operating theater via a neonate delivered by caesarean section and from this infant to the others by a neonatal health care worker who failed to wash hands properly between patients. This is the first documented fatal P. aeruginosa outbreak described at the San Fernando General hospital.     

重症监护病房临床分离需氧菌分布与耐药性分析

目的 了解本院重症监护病房临床分离需氧菌的分布及耐药情况,为临床合理使用抗菌药物提供依据.方法 采用ATB仪进行细菌鉴定,K-B法进行药敏试验及耐药性分析,按CLSI 2011年标准判定药敏结果,并用WHONET5.6软件进行数据分析.结果 分离出的858株病原菌中,常见的主要为肺炎克雷伯氏菌(151株,17.6%)、金黄色葡萄球菌(113株,13.2%)、铜绿假单胞菌(111株,12.9%)、鲍曼不动杆菌(82株,9.5%)、嗜麦芽窄食单胞菌(69株,8.0%)、大肠埃希氏菌(62株,7.2%).从耐药性分析来看,碳青霉烯类仍是敏感率最高的抗生素,但已出现亚胺培南和厄他培南耐药的菌株.葡萄球菌属尚未发现对万古霉素、利奈唑胺、奎奴普丁/达福普汀、替考拉宁耐药株,但对其他多种抗菌药物存在不同程度的耐药性.非发酵菌对多种抗菌药物存在不同程度的耐药性.结论 加强ICU感染管理以及病原菌耐药情况的监测,合理使用抗菌药物,降低临床感染的发生率和病原菌耐药率.     

The evolution of Pseudomonas aeruginosa during antibiotic rotation in a medical intensive care unit: the RADAR-trial

Bacterial spread between patients may contribute to the high prevalence of antibiotic-resistant pathogens within ICUs. The aim of this study was to evaluate the fate of Pseudomonas aeruginosa during the different antibiotic regimens. Susceptibility patterns and genotyping were performed to determine whether there was a predominant clone and to track the spread of resistant strains within the unit. Twenty-eight different ribotypes were found among 82 Pseudomonas isolates. Four ribotypes accounted for 42 (51%) isolates and were designated the "major clones" occurring throughout multiple cycles. The ribotypes with multiple occurrences were more resistant to antibiotics than ribotypes that appeared only once. The correlation of antibiotic use with antibiotic resistance and the finding of a large number of ribotypes suggested that de novo development of antibiotic resistance is a likely event in P. aeruginosa. In addition, ribotypes associated with antibiotic resistance appeared to have a survival advantage and can become frequent colonizers in the ICU.     

Drug use in a surgical intensive care unit

A retrospective review of drug usage in 180 patients admitted to a surgical intensive care unit was conducted. The average stay was three days and the total and daily number of drugs averaged 7.6 and 5.6, respectively. The most common drug class used was antibiotics, with cefazolin being the most commonly used antibiotic. Other commonly used drugs include analgesics, diuretics, H2-antagonists, vasoactive drugs and inotropes, antacids, and antiarrhythmics. This study indicates that patients admitted to a surgical intensive care unit are exposed to a variety of potent drugs, often given in combination over a short time period. Although further studies are needed to delineate specific aspects of drug use and patient characteristics, this study suggests that there is a need for close monitoring of drug therapy in these patients with special attention to reduction of drug costs.     

Characteristics of Pseudomonas aeruginosa isolated from skin infections

From January 1995 to June 2000, 19 Pseudomonas aeruginosa were detected in 19 cases of infectious skin diseases. Coagulase-negative staphylococci coexisted with P. aeruginosa in 10 cases and P. aeruginosa was also often associated with Enterococcus sp., Staphylococcus aureus, Streptococcus sp. or other species. Twelve cases carried P. aeruginosa more predominantly than the other species. Some coagulase-negative staphylococci, Enterococcus sp., S. aureus and Streptococcus sp. were also predominant. The frequency of predominant P. aeruginosa was significantly higher in secondary infections due to ulcers and decubitus than in secondary infections due to other skin diseases. P. aeruginosa was also often detected in the legs and feet, but not in the trunk. This organism showed high sensitivities to antibiotics, except minocycline. No significant differences in sensitivity or resistance to antibiotics were found between P. aeruginosa when detected as the predominant or single strain and this microorganism when detected as the non-predominant strain. Thus, the detection of P. aeruginosa important in choosing the appropriate antibiotics to be used and this is sometimes influenced by the patient's condition.     

Activity of ceftolozane/tazobactam against Pseudomonas aeruginosa and Enterobacterales isolates recovered from intensive care unit patients in Spain: The SUPERIOR multicentre study

Patients in intensive care units (ICUs) present a high risk of developing an infection caused by multidrug-resistant bacteria. Consequently, new antimicrobials and combinations are required. In this study, the activity of ceftolozane/tazobactam (C/T) was evaluated against Enterobacterales (n?=?400) and Pseudomonas aeruginosa (n?=?80) clinical isolates collected from patients in Spanish ICUs with complicated urinary tract infections (cUTI) and complicated intra-abdominal infections (cIAI). Overall susceptibility to C/T in P. aeruginosa isolates by infection type was 95.7% in cUTI (MIC_50/90, 1/4 mg/L) and 85.3% in cIAI (MIC_50/90, 1/64 mg/L). Activity against P. aeruginosa was maintained regardless of its resistance pattern, confirming that C/T is one of the best antipseudomonal agents along with colistin and amikacin. Susceptibility to C/T in Enterobacterales by infection type was 79.5/81.9% and 89.3/92.3% (EUCAST/CLSI) in cIAI and cUTI isolates, respectively. Activity was excellent against wild-type organisms, with 100% susceptible and inhibited at MIC ≤1 mg/L. Nevertheless, C/T susceptibility decreased against extended-spectrum β-lactamase (ESBL)-producing isolates: Escherichia coli (80.4/84.8% susceptible by EUCAST/CLSI) and Klebsiella pneumoniae (59.1/77.3% susceptible by EUCAST/CLSI). No activity of C/T was observed in carbapenemase-producing isolates. The in vitro activity of C/T observed in this surveillance study suggests that this agent can be considered as a therapeutic option for cUTI and cIAI due to Enterobacterales and P. aeruginosa in ICU patients, particularly when carbapenemase-producing isolates are not involved.     

重症监护病房416株革兰阳性菌耐药状况分析

目的：了解重症监护病房（intensive care unit,ICU）革兰阳性（G＋）菌的分布及其耐药性,为临床合理用药提供参考。方法：收集来自ICU各类标本分离的G＋菌,用VITEKAMS-60或VITEK-Ⅱ全自动微生物分析仪进行菌种鉴定,按美国2008年临床和实验标准化研究所（Clinical and Laboratory Standard Institute,CLSI）制定指导原则中的K-B法进行药物敏感试验及结果判断。结果：从ICU中检出的416株G＋菌以凝固酶阴性葡萄球菌为主,有216株（51.9%）。耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）检出率分别占该两类葡萄球菌的80.9%和95.4%。肠球菌呈多重耐药状态。替考拉宁和万古霉素对临床分离的G＋菌均显示强大的抗菌活性,未检出耐药菌株。结论：来自ICU的G＋菌呈现多重耐药性,临床医师和药师应重视耐药监控,预防耐药菌株的产生及流行。