我院重症监护室铜绿假单胞菌感染趋势及其耐药性分析

目的铜绿假单胞菌（Pseudomonas aeruginosa,PA）为院内感染的重要代表菌及临床分离率较高的菌株,在我院PA占所有菌株检出率的24.5%、占革兰阴性杆菌检出率的35.4%。通过对我院2006年1月-2009年6月期间4个重症监护室铜绿假单胞菌的感染情况及其耐药性进行分析,并与同期非重症监护室的病区进行比较,分析PA产碳青霉烯酶水解碳青霉烯类抗生素后同时携带多种耐药基因对其他药物敏感性的影响。方法采用Micro Scan全自动细菌鉴定和药敏分析仪,数据的分析采用WHONET软件。结果 4年间我院重症监护室铜绿假单胞菌检出数为559株,依次为：内科ICU272株、外科ICU149株、急诊ICU126株、儿科ICU12株。药敏结果显示：铜绿假单胞菌对大部分抗生素的敏感性呈逐年下降的趋势,尤其是重症监护室感染菌株。PA对碳青霉烯类抗菌素耐药的菌株产生多重甚至广泛耐药的几率较高。结论 4年间我院重症监护室铜绿假单胞菌对抗生素的耐药状况严重,尤其对头孢菌素,氨基糖苷类抗生素耐药率明显增加。对亚胺培南的耐药株同时携带多种耐药机制,产生多重耐药甚至泛耐药。多重耐药株和泛耐药株的检出亦呈逐年上升的趋势。

Analysis of Trends of Infection and Drug Resistance of Pseudomonas aeruginosa in Intensive Care Unit in Our Hospital

Objective Pseudomonas aeruginosa is an important representative bacterial strain with high isolation rate of nosocomial infections in our hospital accounted for 24.5% and 35.4% of the total and the Gram-negative bacilli detection rate,respectively. Pseudomonas aeruginosa infection surveillance and drug resistance analysis were performed in four intensive care units of our hospital from Jan2006 to June2009,and compared with the non-intensive care units at the same period. The effect of producing carbapenemase hydrolyzing carbapenems in PA carrying multidrug resistant genes on the sensitivity to other drugs was also analyzed. Methods Micro Scan automatic bacterial identification and susceptibility analyzers were used. And WHNET software was used in data analysis. Results During the four years,in the intensive care units of our hospital 559 strains of Pseudomonas aeruginosa were identified,in which internal medicine ICU 272 strains,surgical ICU 149 strains,emergency ICU 126 strains,pediatric ICU 12 strains. Results from drug susceptibility showed that the sensitivity of PA to most antibiotics trends to decline year by year,particularly the ICU infectious strains. To the carbapenem antibiotic-resistant strains,PA has a multiple or even a higher possibility of extensive drug-resistance. Conclusion During the four years,in the intensive care units of our hospital PA resistance to antibiotics was serious,especially to cephalosporins and aminoglycoside antibiotics,and the resistance rate has increased significantly. Drug-resistant strains resistant to imipenem （IRPA） carrying multi-drug resistant mechanisms generate multi-drug resistance,even pan-resistance. Multi-drug resistant and pan-resistant strains were increasing year by year.