耐碳青霉烯类抗菌药物的铜绿假单胞菌医院感染特征分析

目的 探讨耐碳青霉烯类抗菌药物的铜绿假单胞菌的医院感染特征，推动医院感染耐药细菌的防治工作。方法 选取2005年1～8月该院经病原学及药敏试验证实为耐碳青霉烯类铜绿假单胞菌感染，且诊断为医院感染的临床病例作为分析对象，共63例，所有菌株均为对碳青霉烯类抗菌素“耐药”菌株。结果 在分离的63例中，61例为该院医院感染病例，2例为他院“输入”医院感染病例。同期共检出医院感染铜绿假单胞菌90例，此类耐药菌株占同期医院感染铜绿假单胞菌株的70％。63例均为下呼吸道感染病例，标本均为痰液及支气管灌洗液；其中耐亚胺培南有63例，耐美罗培南者49例，二者全部耐药49例。对其他常用抗菌素药物耐药情况如下：耐药程度低的药物分别为头孢哌酮-舒巴坦、头孢吡肟及头孢他定；耐药程度高的分别为庆大霉素、复方新诺明及哌拉西林；在耐碳青霉烯类铜绿假胞菌医院感染的临床因素中，发现广谱抗感染药物联合应用、高龄、住院时间较长、昏迷及纤维支气管镜操作、气管插管或切开及原有肺部的基础疾病等可能为此类感染发生的高危险因素。结论 医院感染中的耐碳青霉烯类的铜绿假单胞菌均为多重耐药菌，仅头孢哌酮-舒巴坦、头孢吡肟及头孢他定等部分药物对这类细菌耐药程度低，可供临床治疗参考选择；其在医院内的发生与传播与多种因素有关，对该类感染一定要采取严格的隔离预防措施，积极控制，及时遏止其在医院内的传播和流行。

Clinical analysis of carbapenem-resistant Pseudomonas aeruginosa in hospital infections

Objective To study the clinical characterization of carbapenem-resistant Pseudomonas aeruginosa in hospital infections, to improve the therapy and prevention methods for multi-resistant bacterial infection. Method The 63 clinical cases diagnosed Pseudomonas aeruginosa hospital infection by pathogenic detection and susceptibility methods were selected. All bacteria strains from these cases were carbapenem-resistant. Results 61 cases infected by carbapenem-resistant Pseudomonas aeruginosa were from Nanfang hospital, the other 2 cases were from other hospitals; Meantime, there were totally 147 Pseudomonas aeruginosa hospital infection cases were observed; Carbapenem-resistant Pseudomonas aeruginosa occupied 42.9%; 63 cases were lower respiratory infectious diseases, all the samples for study were sputum and bronchial alveolar lavage fluid. 63 cases were imipenem-resistant, 49 caeses were Meropenem-resistant, and 49 cases were both Imipenem and Meropenem-resistant; another general antibiotics-resistant as followings; the antibiotics with low resistant degree were: Cefoperazone-Sulbactam, Cefepime and Ceftazidime, respectively; and with high resistant degree were: Gentamycin, Compound Sulfamethoxazole and Piperacillin, aeruginosa respectively; The relationship between clinical factors and arbapenem-resistant Pseudomonas infections were also studied. Our results showed that clinical factors, such as the combined application of broad-specrum antimicrobial agents, senility, Long-term inpatients, coma, fiberoptic bronchoscopy use, bronchial intubation or bronchotomy and primary lung diseases were high risks to this kind of hospital infections. Conclusion The most of carbapenem-resistan Pseudomonas aeruginosa in hospital acquired infections were multi antibiotics-resistant. Only Cefoperazone-Sulbactam, Cefepime and Ceftazidime were selected for clinical use due to their low-resistant level. Many clinical factors are related with occurrence and epidemic of hospital infections. Severe isolation and prevention method should be adopted to control and bock its transmission.