医院铜绿假单胞菌耐药性变迁及临床对策

目的探讨医院内铜绿假单胞菌(PAE)的耐药性及其变迁,指导临床合理用药. 方法对2001～2003年病房临床分离的PAE 1 126株, 用26种抗菌药物进行药敏实验. 结果三代头孢菌素的头孢他啶耐药率为30.91%,头孢哌酮/舒巴坦的总耐药率为19.97%,四代头孢菌素的头孢吡肟的耐药率为23.27% ;碳青酶烯类的亚胺培南和美罗培南的耐药率分别是39.42%和36.63%;氨基糖苷类的耐药率都＜30%,以阿米卡星和妥布霉素最低,分别6.92%和11.23%;氟喹诺酮类的耐药率均＞44%. 结论 PAE的耐药性已十分突出,对于PAE的感染, 应在药敏指导下用药,经验性治疗则首选头孢哌酮/舒巴坦或头孢吡肟 阿米卡星或妥布霉素组合治疗方案;应该适当控制三代头孢菌素、碳青酶烯类和氟喹诺酮类药物的使用.

Antibiotic Resistance of Pseudomonas aeruginosa in Hospital: Dynamics and Clinical Antimicrobial Strategy

OBJECTIVE To investigate the change in antibiotic resistance of Pseudomonas aeruginosa (PA) in hospital for reference of clinical antimicrobial strategy. METHODS Data were collected of the 1128 bacteria strains isolated from clinical specimens from Jan 2001 to Dec 2003. Drug sensitivity tests were made for 26 antimicrobial agents. RESULTS Drug-resistance rate of ceftazidime was 30.91%, cefoperazone-sulbactam 19.97%, cefepime 23.27%, imipenem30.42%,meropenem36.63%. The drug resistance rates of all aminoglycoside antibiotics tested were lower than 30%, with amikacin 6.92%, tobramycin 11.23%. The resistance rates of all fluoroquinolones tested were higher than 44%. CONCLUSIONS The drug resistance of PA is highly prominent. Antimicrobial treatment with PA infection should be guided by drug sensitivity test. While the first choice for experimental treatment is cefoperazone-sulbactam or cefepime + amikacin or tobramycin. The usage of the third generation cephalosporins, carbapenems, as well as fluoroquinolones needs to be strategically controlled.