SARI: Surveillance der Antibiotikaanwendung und bakteriellen Resistenzentwicklung auf deutschen Intensivstationen

Intensive care units (ICUs) are considered to be high-risk areas for the emergence and spread of multiresistant bacterial pathogens. In Germany, there are no representative epidemiological data on antibiotic resistance, on the use of antibiotics in ICUs, or on the correlation between antibiotic use and the emergence of resistance. Project SARI (surveillance of antibiotic use and bacterial resistance in ICUs), which as a part of the epidemiological network Spread of Nosocomial Infections and Resistant Pathogens (SIR) is supported by the German Ministry of Science and Education, started in February 2000 and meanwhile includes data on antibiotic use and resistance rates in 38 medical, surgical, and interdisciplinary ICUs. To date (February 2000-June 2003), a total of 1142 months, 413,065 patient days, and 550,288 defined daily doses (DDDs in accordance with the WHO) have been covered with a mean antibiotic usage density (AD) of 1335 DDDs/1000 patient days and resistance data on 37,612 isolates from ICUs. Ciprofloxacin use and MRSA correlate significantly, as do imipenem use and the rate of imipenemresistant P. aeruginosa.The genodiversity of P. aeruginosa is lower in ICUs with high resistance rates and low use of imipenem than in ICUs with high resistance rates and high use. This is an indirect parameter of transmission of identical strains.The epidemiological data of SARI form a basis for improved antibiotic and infection control management in ICUs (http://www.sari-antibiotika.de).     

重症监护病房耐亚胺培南铜绿假单胞菌耐药机制和分子分型的研究

目的 分析重症监护病房(intensive care unit,ICU)耐亚胺培南铜绿假单胞菌的耐药特征及其耐药机制. 方法 收集2018年1月-2019年9月广州市某医院ICU分离的37株耐亚胺培南铜绿假单胞菌(imipenem resistant Pseudomonas aeruginosa,IRPA),使用微生物...     

Emergence of resistance in Pseudomonas aeruginosa and Acinetobacter species after the use of antimicrobials for burned patients.

OBJECTIVES: To evaluate the emergence of resistance of Pseudomonas aeruginosa and Acinetobacter species to imipenem, ciprofloxacin, or both after the use of these drugs and to compare resistant with susceptible isolates by molecular typing. DESIGN: Cohort study. SETTING: Burn intensive care unit (ICU) with 4 beds in a tertiary-care university hospital. METHODS: During 16 months, surveillance cultures were performed for all patients admitted to the ICU. Demographic information was obtained for each patient. Molecular typing was done by pulsed-field gel electrophoresis using restriction enzymes for 71 isolates of P. aeruginosa and Acinetobacter species. RESULTS: Thirty-four patients were admitted and 22 were colonized by susceptible P. aeruginosa or Acinetobacter species before they used the antimicrobials. Nine (41%) of these patients had a resistant isolate after antimicrobial use: 5 had used imipenem alone, 1 had used ciprofloxacin, and 3 had used both drugs. The interval between isolation of the susceptible and resistant isolates ranged from 4 to 25 days, but was 10 or more days for 6 patients. Molecular typing revealed that susceptible and resistant isolates from each patient were different and that although there were no predominant clones among susceptible isolates, there was a predominant clone among resistant isolates of P. aeruginosa and of Acinetobacter. CONCLUSIONS: Resistance was not due to the acquisition of resistance mechanisms by a previously susceptible strain, but rather to cross-transmission. Although various measures involving antimicrobial use have received great attention, it would seem that practices to prevent cross-transmission are more important in controlling resistance.     

Methicillin-resistant Staphylococcus aureus in German intensive care units during 2000-2003: data from Project SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in Intensive Care Units).

OBJECTIVES: The objective of this study was to analyze methicillin-resistant Staphylococcus aureus (MRSA) percentages (defined as the percentage of S. aureus isolates that are resistant to methicillin) and antimicrobial consumption in intensive care units (ICUs) participating in Project SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in Intensive Care Units), to look for temporal changes in MRSA percentages and antimicrobial consumption in individual ICUs as an indicator of the impact of an active surveillance system, and to investigate the differences between ICUs with increased MRSA percentages versus those with decreased percentages during a period of 3 years (2001-2003). METHODS: This was a prospective, ICU-based and laboratory-based surveillance study involving 38 German ICUs during 2000-2003. Antimicrobial use was reported in terms of defined daily doses (DDDs) per 1,000 patient-days. Temporal changes in the MRSA percentage and antimicrobial use in individual ICUs were calculated by means of the Wilcoxon signed rank test. The incidence density of nosocomial MRSA infection was defined as the number of nosocomial MRSA infections per 1,000 patient-days. RESULTS: From February 2000 through December 2003, a total of 38 ICUs reported data on 499,694 patient-days and 9,552 S. aureus isolates, including 2,249 MRSA isolates and 660,029 DDDs of antimicrobials. Cumulative MRSA percentages ranged from 0% to 64.4%, with a mean of 23.6%. The MRSA incidence density ranged from 0 to 38.2 isolates per 1,000 patient-days, with a mean of 2.77 isolates per 1,000 patient-days. There was a positive correlation between MRSA percentage and imipenem and ciprofloxacin use (P<.05). Overall, comparison of data from 2001 with data from 2003 showed that MRSA percentages increased in 18 ICUs (median increase, 13.2% [range, 1.6%-38.4%]) and decreased in 14 ICUs (median decrease, 12% [range, 1.0%-48.4%]). Increased use of third-generation cephalosporins, glycopeptides, or aminoglycosides correlated significantly with an increase in the MRSA percentage (P<.05). The cumulative nosocomial MRSA infection incidence density for 141 ICUs that did not participate in SARI and, therefore, did not receive feedback increased from 0.26 to 0.35 infections per 1,000 patient-days during a 3-year period, whereas the rate in SARI ICUs decreased from 0.63 to 0.40 infections per 1,000 patient-days. CONCLUSION: The MRSA situation in German ICUs is still heterogeneous. Because MRSA percentages range from 0% to 64.4%, further studies are required to confirm findings that no change in the MRSA percentage and a decrease in the nosocomial MRSA infection incidence density in SARI ICUs reflect the impact of an active surveillance system.     

某院2016年ICU与普通病房铜绿假单胞菌耐药性对比分析

目的了解某院2016年重症监护病房（ICU）与普通病房铜绿假单胞菌分布状况及其耐药性,为临床合理使用抗菌药物提供科学依据。方法采用VITEK 2 Compact 全自动微生物分析系统对该院2016年临床分离菌株进行鉴定及药敏试验, 比较ICU与普通病房铜绿假单胞菌耐药性的差异。结果ICU与普通病房送检标本均以痰为主,分别占78.7%、66.5%。ICU铜绿假单胞菌的检出率（11.7%）与普通病房（11.0%）比较,差异无统计学意义（P＞0.05）。ICU检出的铜绿假单胞菌对氨曲南耐药率最高,达73.8% ,对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢他啶、亚胺培南、美罗培南的耐药率也高达50%以上;普通病房检出的铜绿假单胞菌对氨曲南耐药率最高,达59.6%,其次是哌拉西林/他唑巴坦、亚胺培南,分别为48.0%、44.3%;ICU铜绿假单胞菌对被检测的12种抗菌药物耐药率均高于普通病房（P＜0.05）。结论ICU铜绿假单胞菌的耐药率高于普通病房,应引起临床高度重视;临床上治疗其感染时,应根据药敏试验结果合理选用抗菌药物。     

Imipenem resistance among pseudomonas aeruginosa isolates: risk factors for infection and impact of resistance on clinical and economic outcomes.

OBJECTIVES: To identify risk factors for infection with imipenem-resistant Pseudomonas aeruginosa and determine the impact of imipenem resistance on clinical and economic outcomes among patients infected with P. aeruginosa. DESIGNS: An ecologic study, a case-control study, and a retrospective cohort study. SETTING: A 625-bed tertiary care medical center. PATIENTS: All patients who had an inpatient clinical culture positive for P. aeruginosa between January 1, 1999, and December 31, 2000. RESULTS: From 1991 through 2000, the annual prevalence of imipenem resistance among P. aeruginosa isolates increased significantly (P<.001 by the chi (2) test for trend). Among 879 patients infected with P. aeruginosa during 1999-2000, a total of 142 had imipenem-resistant P. aeruginosa infection (the case group), whereas 737 had imipenem-susceptible P. aeruginosa infection (the control group). The only independent risk factor for imipenem-resistant P. aeruginosa infection was prior fluoroquinolone use (adjusted odds ratio, 2.52 [95% confidence interval {CI}, 1.61-3.92]; P<.001). Compared with patients infected with imipenem-susceptible P. aeruginosa, patients infected with imipenem-resistant P. aeruginosa had longer subsequent hospitalization durations (15.5 days vs 9 days; P=.02) and greater hospital costs (81,330 dollars vs 48,381dollars ; P<.001). The mortality rate among patients infected with imipenem-resistant P. aeruginosa was 31.1%, compared with 16.7% for patients infected with imipenem-susceptible P. aeruginosa (relative risk, 1.86 [95% CI, 1.38-2.51]; P<.001). In multivariable analyses, there remained an independent association between infection with imipenem-resistant P. aeruginosa and mortality. CONCLUSIONS: The prevalence of imipenem resistance among P. aeruginosa strains has increased markedly in recent years and has had a significant impact on both clinical and economic outcomes. Our results suggest that curtailing use of other antibiotics (particularly fluoroquinolones) may be important in attempts to curb further emergence of imipenem resistance.     

耐亚胺培南铜绿假单胞菌的基因多态性研究

目的应用随机扩增多态性DNA(RAPD)技术,对耐亚胺培南铜绿假单胞菌进行基因多态性研究。方法对医院临床分离的8株耐亚胺培南铜绿假单胞菌进行随机引物聚合酶链反应(PCR)扩增,扩增产物进行电泳和聚类分析。结果耐亚胺培南铜绿假单胞菌耐药表型相同,但基因型相同,绝大多数基因型不同。结论通过RAPD分析了解耐亚胺培南铜绿假单胞菌基因型的特性,明确耐亚胺培南铜绿假单胞菌耐药的表型与基因型的关系,为该菌的感染控制提供分子流行病学依据。     

山东省101所医院重症监护病房患者分离细菌及耐药性特征

目的了解山东省重症监护病房(ICU)细菌分布及耐药情况。方法收集2014年山东省101所医院ICU及106所医院普通病房(非ICU)分离细菌的药敏数据,进行统计分析。结果共收集细菌24 458株,革兰阴性菌占80.37%,革兰阳性菌占19.63%。ICU分离居前5位的细菌依次为:肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌。来源于ICU的大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、黏质沙雷菌对碳青霉烯类药物、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、阿米卡星耐药率高于非ICU来源菌株(均P0.01)。ICU分离鲍曼不动杆菌、铜绿假单胞菌、葡萄球菌属细菌对常用抗菌药物耐药率高于非ICU菌株(P0.05)。ICU分离鲍曼不动杆菌对亚胺培南和美罗培南耐药率分别为78.0%、79.0%;铜绿假单胞菌对前述药物耐药率分别为25.5%、21.6%,对其他常用抗菌药物的耐药率30.0%。ICU耐甲氧西林金黄色葡萄球菌(MRSA)检出率为39.7%,高于非ICU的26.0%(P0.05)。结论 ICU分离细菌耐药情况比较严重,应依据药敏结果指导抗菌药物合理应用,防止耐药菌感染扩散。     

How many nosocomial infections are associated with cross-transmission? A prospective cohort study in a surgical intensive care unit.

OBJECTIVE: To determine the percentage of cross-transmissions in an intensive care unit (ICU) with high nosocomial infection (NI) rates according to the data of the German Nosocomial Infection Surveillance System. SETTING: A 14-bed surgical ICU of a 1,300-bed, tertiary-care teaching hospital. METHOD: Prospective surveillance of NIs during a period of 9 months. If an NI was present, the isolates of the following indicator pathogens were stored and typed by species: Staphylococcus aureus, Enterococcus species, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacter species. Pulsed-field gel electrophoresis was performed for typing of S. aureus strains and arbitrarily primed polymerase chain reaction was applied for the other pathogens. The presence of two indistinguishable strains in two patients was considered as one episode of cross-transmission. RESULTS: Two hundred sixty-two patients were observed during a period of 2,444 patient-days; 96 NIs were identified in 59 patients and the overall incidence density of NI was 39.3 per 1,000 patient-days. For 104 isolates, it was possible to consider typing results. Altogether, 36 cross-transmissions have lead to NIs in other patients. That means at least 37.5% of all NIs identified were due to cross-transmissions. CONCLUSION: Because of the method of this study, the percentage of NIs due to cross-transmission identified for this ICU is an "at least number." In reality, the number of cross-transmissions, and thus the number of avoidable infections, may have been even higher. However, it is difficult to assess whether the percentage of NIs due to cross-transmission determined for this ICU may be the crucial explanation for the relatively high infection rate in comparison to other surgical ICUs.     

Temporal changes in prevalence of antimicrobial resistance in 23 US hospitals

Antimicrobial resistance is increasing in nearly all health-care-associated pathogens. We examined changes in resistance prevalence during 1996-1999 in 23 hospitals by using two statistical methods. When the traditional chi-square test of pooled mean resistance prevalence was used, most organisms appear to have increased in prevalence. However, when a more conservative test that accounts for changes within individual hospitals was used, significant increases in prevalence of resistance were consistently observed only for oxacillin-resistant Staphylococcus aureus, ciprofloxacin-resistant Pseudomonas aeruginosa, and ciprofloxacin- or ofloxacin-resistant Escherichia coli. These increases were significant only in isolates from patients outside intensive-care units (ICU). The increases seen are of concern; differences in factors present outside ICUs, such as excessive quinolone use or inadequate infection-control practices, may explain the observed trends.     

铜绿假单胞菌的耐药性变化及其DNA多态性分析

目的了解2001-2006年间铜绿假单胞菌的耐药性变化趋势并且对其DNA多态性进行分析。方法使用VITEK全自动微生物鉴定仪对铜绿假单胞菌临床分离株进行鉴定,药敏试验采用Kirby-bauer(KB)法,对分离的10株敏感株和8株耐药株进行随机引物PCR扩增。结果亚胺培南和头孢他啶的敏感性最强,头孢哌酮、哌拉西林、阿米卡星和环丙沙星的敏感率均超过50%;10株敏感菌分为8种基因型,8株耐药菌分为5种基因型。结论铜绿假单胞菌对多种抗菌药物较敏感,其耐药表型与其基因型之间具有一定的相关性。     

Nosocomial bacterial infections and their antimicrobial resistance patterns in university hospitals of hamedan, iran

Background: Nosocomial infections constitute a global health problem, leading to a high rate of morbidity and mortality. The aim of this study was to determine the frequency and antimicrobial resistance patterns of nosocomial infections in edu-cational hospitals of Hamadan, western Iran.Methods: During a 1-year period from April 2006 to March 2007, all patients with cul-ture-proven nosocomial infections from educational hospitals in Hamedan, west-ern Iran were included. Nosocomial infections were defined as a culture-proven infection, which occurred more than 48h after admission in the hospital. An-timicrobial susceptibility testing of isolated bacteria was performed by disc dif-fusion method. Results: A total of 170 cases of culture-proven nosocomial infections were diag-nosed. Most cases were in intensive care units (ICUs) (57.4%). The common sites of infection were lower respiratory tract (51.8%) and urinary tract (31.9%). Kleb-siella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli, were the most prevalent pathogens (32.7%, 22.9%, and 14.8% respectively). Most en-terobacteriacea isolates were resistant to third generation cephalosporins. The resis-tant rates to ceftriaxone were 75.5% for K. pneumoniae, and 76% for E. coli. Among P. aeruginosa isolates, 26.5% were resistant to ceftazidim, and 36% to cipro-floxacin. Among S. aureus isolates, 80% were methicillin-resistant. Conclusion: The patients in the ICUs are at a higher risk of nosocomial infec-tions. The high prevalence of antimicrobial resistance in the hospitals highlights the need of further infection control activities and surveillance programs.     

铜绿假单胞菌对亚胺培南的耐药水平调查及药敏分析

目的了解2009年3月-2010年7月岳阳市一人民医院住院患者送检标本分离的铜绿假单胞菌对亚胺培南的耐药水平,并分析亚胺培南耐药株对其他常用抗菌药物的耐药性。方法临床标本分离的铜绿假单胞菌用常规K-B法进行药物敏感试验,若结果判定为耐药和中介,则进一步采用琼脂倍比稀释法检测铜绿假单胞菌对亚胺培南及其他9种抗菌药物的MIC。结果铜绿假单胞菌对亚胺培南的耐药率为13.5%,20株耐亚胺培南的铜绿假单胞菌对9种常用抗菌药物的耐药率也普遍较高,有2株铜绿假单胞菌对受试的10种抗菌药物全部耐药。结论铜绿假单胞菌对亚胺培南的耐药率较高,并对多种抗菌药物耐药,应密切关注本地区细菌耐药性的变迁,适时调整治疗方案,合理应用抗菌药物。     

耐亚胺培南铜绿假单胞菌的感染现状及耐药性分析

目的 探讨医院耐亚胺培南铜绿假单胞菌(PAE)的感染现状及耐药性,为临床医师合理用药提供依据.方法 收集医院2008年1月-2010年12月临床分离的128株耐业胺培南铜绿假单胞菌的感染现状及耐药性进行回顾性分析 结果 耐业胺培南铜绿假单胞菌主要分布在ICU、脑病科、肿瘤科,分别占60.9％、21.9％、8.6％;在各类标本中的检出率以痰液、脓液、创面分泌物较高,分别占 60.2％、12.5％、12.5％;耐亚胺培南铜绿假单胞菌对黏菌素B耐药率最低为0,对头孢他啶、阿米卡星耐药率相对较低,为40.62％、46.09％;耐药率＞80.0％的有磺胺甲噁唑/甲氧芐啶、头孢噻肟、美罗培南、氨曲南、环丙沙星、庆大霉素、左氧氟沙星;耐药率＞ 50.0％的有哌拉西林、头孢哌酮/舒巴坦、哌拉西林/舒巴坦.结论 耐亚胺培南铜绿假单胞菌多药耐药现象极为严重,应加强耐药监测,合理使用抗菌药物,严防耐亚胺培南铜绿假单胞菌的蔓延.     

Temporal changes in bacterial resistance in German intensive care units, 2001-2003: data from the SARI (surveillance of antimicrobial use and antimicrobial resistance in intensive care units) project

Conservative testing revealed a stable antibiotic resistance situation for Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae and Enterobacter cloacae in 32 German intensive care units (ICUs) actively participating in the SARI (surveillance of antimicrobial use and antimicrobial resistance in ICUs) project over a three-year period (2001--2003). No significant changes were shown for methicillin-resistant S. aureus (MRSA) (P=0.501; the MRSA rate increased in 18 ICUs and decreased in 14 ICUs). The only exception was an increase in ciprofloxacin-resistant E. coli.     

耐亚胺培南铜绿假单胞菌医院感染现状及监测

目的探讨耐亚胺培南铜绿假单胞菌医院感染现状及其对13种常用抗菌药物的耐药性,指导临床合理选用抗菌药物. 方法用常规方法对289株铜绿假单胞菌临床株进行鉴定,并采用Kirty-Bauer法选用13种抗菌药物进行药物敏感试验. 结果 106株耐亚胺培南铜绿假单胞菌的分离率为36.7%,主要来源于痰标本,占78.3%;其在临床病区分布中居前3位者依次为呼吸内科、神经外科、老年病科;106株铜绿假单胞菌对氯霉素、复方新诺明等8种抗菌药物均表现出＞50%的耐药率. 结论耐亚胺培南铜绿假单胞菌医院感染严重,对抗菌药物呈多重耐药,治疗此类细菌感染宜参考细菌药敏结果合理选用抗菌药物.     

Relationship between rates of antimicrobial consumption and the incidence of antimicrobial resistance in Staphylococcus aureus and Pseudomonas aeruginosa isolates from 47 French hospitals.

OBJECTIVE: To investigate relationships between rates of antimicrobial consumption and the incidence of antimicrobial resistance in Staphylococcus aureus and Pseudomonas aeruginosa isolates from hospitals. METHODS: We conducted an observational study that used retrospective data from 2002 and linear regression to model relationships. Hospitals were asked to collect data on consecutive S. aureus and P. aeruginosa isolates, consumption rates for antibiotics (ie, anti-infectives for systemic use as defined by Anatomical Therapeutic Chemical class J01), and hospital characteristics, including infection control policies. Rates of methicillin resistance in S. aureus and rates of ceftazidime and ciprofloxacin resistance in P. aeruginosa were expressed as the percentage of isolates that were nonsusceptible (ie, either resistant or intermediately susceptible) and as the incidence of nonsuceptible isolates (ie, the number of nonsuceptible isolates recovered per 1,000 patient-days). The rate of antimicrobial consumption was expressed as the number of defined daily doses per 1,000 patient-days. SETTING: Data were obtained from 47 French hospitals, and a total of 12,188 S. aureus isolates and 6,370 P. aeruginosa isolates were tested. RESULTS: In the multivariate analysis, fewer antimicrobials showed a significant association between the consumption rate and the percentage of isolates that were resistant than an association between the consumption rate and the incidence of resistance. The overall rate of antibiotic consumption, not including the antibiotics used to treat methicillin-resistant S. aureus infection, explained 13% of the variance between hospitals in the incidence of methicillin resistance among S. aureus isolates. The incidence of methicillin resistance in S. aureus isolates increased with the use of ciprofloxacin and levofloxacin and with the percentage of the hospital's beds located in intensive care units (adjusted multivariate coefficient of determination [aR(2)], 0.30). For P. aeruginosa, the incidence of ceftazidime resistance was greater in hospitals with higher consumption rates for ceftazidime, levofloxacin, and gentamicin (aR(2), 0.37). The incidence of ciprofloxacin resistance increased with the use of fluoroquinolones and with the percentage of a hospital's beds located in intensive care ( aR(2), 0.28). CONCLUSIONS: A statistically significant relationship existed between the rate of fluoroquinolone use and the rate of antimicrobial resistance among S. aureus and P. aeruginosa isolates. The incidence of resistant isolates showed a stronger association with the rate of antimicrobial use than did the percentage of isolates with resistance.     

Clinical surveillance of surgical imipenem-resistant Pseudomonas aeruginosa infection in a Japanese hospital

In order to elucidate any changes in imipenem-resistant Pseudomonas aeruginosa (IRPA) infections in Japan, we examined 511 P. aeruginosa stains isolated from our surgical ward between 1987 and 2001. These isolates were subjected to susceptibility testing against various antipseudomonal agents including imipenem, meropenem, ceftazidime, gentamicin and ciprofloxacin. They were serotyped with the slide agglutination test and genotyped using pulsed-field gel electrophoresis (PFGE). The annual incidences of IRPA infections were particularly high in the early 1990s. Epidemiological investigations revealed that these outbreaks were due to dissemination of hospital-acquired IRPA isolates. Intensive use of imipenem promoted the selection of highly resistant strains. Further study of resistance mechanisms revealed that none of the 110 IRPA strains were metallo-beta-lactamase (MBL) producers. Polymerase chain reaction (PCR) analysis using bla(IMP) specific primers confirmed that no IMP-1 type MBL gene-positive strains were detected from our ward. Susceptibilities of those IRPA strains against other antipseudomonal agents showed relatively low levels, suggesting that imipenem resistance was mainly due to impermeability of the OprD porin. In conclusion, hospital-acquired outbreaks of IRPA were recently reduced by guidelines for, and surveillance of, appropriate use of antimicrobial agents. When the rate of IRPA isolation increases, serotyping should be performed initially and PFGE is required to confirm outbreaks. A computer-assisted genotyping technique is available to perform epidemiological studies of IRPA isolates.     

耐亚胺培南铜绿假单胞菌的耐药性及分子流行病学研究

目的了解广州市某医院烧伤科病房亚胺培南耐药铜绿假单胞菌的耐药谱特点及分子流行病学情况。方法采用Kirby-Bauer法进行药物敏感性试验,应用随机扩增DNA多态性分析(RAPD)技术,对从不同患者连续分离到的48株耐药菌进行DNA分型。结果48株亚胺培南耐药菌株均为多重耐药菌,对临床常用的多种抗菌药物耐药,敏感率由高到低依次为CIP、TOB、AMK、GEN和FEP;RAPD图谱显示48株菌分别属于A、B、C、D 4个不同克隆,其中A型、B型是主要流行克隆。结论该院烧伤科病房亚胺培南耐药铜绿假单胞菌的流行主要是医院感染所致,流行株呈多重耐药。     

老年呼吸机相关性肺炎感染铜绿假单胞菌的耐药性分析

目的研究老年呼吸机相关性肺炎(VAP)铜绿假单胞菌(PAE)感染及耐药特征,为临床合理选用抗菌药物提供依据。方法对256例使用呼吸机治疗的老年住院患者进行目标监测,对分离的铜绿假单胞菌采用纸片扩散法进行药敏试验,并对抗菌药物耐药结果进行回顾性分析。结果 63株铜绿假单胞菌对阿米卡星的耐药率最低,为23.81%,其次为庆大霉素、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、亚胺培南、美罗培南、左氧氟沙星,耐药率为34.92%～53.97%,对其余8种抗菌药物的耐药率为55.56%～100.00%;共检出34株耐亚胺培南PAE,3株泛耐药菌株。结论铜绿假单胞菌对常用抗菌药物呈多药耐药;VAP感染已十分严重,应引起临床医师的重视;治疗应选择科学的联合用药方案;首选药物为头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、亚胺培南、美罗培南。