多重耐药铜绿假单胞菌判定方法探讨

目的探讨多重耐药铜绿假单胞菌（MDR—PA）的监测方法，分析MDR—PA的耐药情况。方法收集2009年1月至2011年12月我院分离的铜绿假单胞菌（PA）591株，将11种抗菌药物分为6大类，筛查MDR—PA，分析MDR—PA的耐药性。细菌鉴定和药敏试验采用VITEK2Compact全自动细菌培养鉴定仪。结果在6大类抗菌药物中，耐药率最高的为氨基糖苷类（34．2％、163／477），最低的为碳青霉烯类（12．9％、76／591）。除碳青霉烯类一氨基糖苷类-力口酶抑制剂复合类外（18例），其他含有碳青霉烯类的9组，MDR—PA监测结果均≤9例，而非含有碳青霉烯类的10组，MDR—PA监测结果均≥22例。氨苄西林、氨苄西林／舒巴坦、头孢唑啉、呋喃妥因、头孢呋辛酯、复方新诺明在6类抗菌药物中耐药率均〉95．4％；左旋氧氟沙星、头孢他啶、氨曲南、环丙沙星、头孢吡肟和哌拉西彬他唑巴坦对耐碳青霉烯类的PA抗菌活性尚可（耐药率27．6％～35．1％），对其他5类非耐碳青霉烯类的PA抗菌活性最好的是亚胺培南（耐药率13．7％-24．0％）；对其他5类非耐氟喹诺酮类的PA抗菌活性中，左旋氧氟沙星、环丙沙星抗菌活性尚可（耐药率27．6％～49．0％）。结论筛查MDR—PA时，应优先选择耐头孢菌素类、加酶抑制剂复合类、氨基糖苷类、单环β-内酰胺类，少选择耐碳青霉烯类，以便提高MDR—PA的检出率。

Discussion of multiple drug resistance to pseudomonas aeruginosa

Objective To study the surveillance of muhidrug-resistance to Pseudomonas aeruginosa （ MDR- PA） and to investigate drug resistance of MDR-PA. Methods A total 591 strains of Pseudomonas aeruginosa （PA） were collected from Jan. 2009 to Dec. 2011. 11 strains resistant drugs were identified and were detected as MDR-PA. Results The highest resistance rate （ 34.2% ） to six kinds of antibiotics is aminoglycosides and the Iowest resistance rate （ 12. 9% ） was Carbapenems. Except for carbapenems-Aminoglycosides-Eneyme inhibitors compound class （18 strains）, testing result of MI）R-PA was in 9 teams. Other antibiotics that contained carbapenems were less than 9 strains. But the opposite MDR-PA was more than 23 strains. The resistance rate of AMP, SAM,CZO, NIT, CXA, SXT was all higher than 95.4%. LVX, CAZ, ATM, CIP, FEP and TZP was not highly sensitive to PA＇ s antibacterial activity （ resistance rate was 27. 6%-35. 1% ）. IPM had significant antibacterial activity （ resistance rate is 13.7% -24.0% ）. Conclusions It is important to select the drug resistance isolates of cephalosporin, enzyme inhibitors compound, aminoglycosides and monocycle β-1actam antibiotic to improve the isolate rate of MDR-PA.