2015－2018年医院铜绿假单胞菌的临床分布及耐药趋势分析

目的 了解临床分离铜绿假单胞菌(PA)的分布特点及耐药性特征，为临床合理使用抗菌药物提供参考依据。方法 收集某院2015年1月至2018年12月临床标本分离的PA，用全自动微生物鉴定仪进行菌种鉴定及抗菌药物敏感性试验，数据采用WHONET5.6软件和SPSS22.0统计软件进行分析。结果 4年共检出PA 2251株，每年PA占所有分离的革兰阴性菌的比率分别为15.46%、13.72%、14.14%和12.89%。标本来源主要为呼吸道标本(76.50%)，科室分布主要为ICU、呼吸科和康复科。药敏试验表明，PA对氨曲南、亚胺培南、美罗培南的耐药率均＞30%，对头孢哌酮/舒巴坦的耐药率在21.6%~40%，对左氧氟沙星的耐药率在20.3%~32.5%，对头孢他啶、环丙沙星、头孢吡肟、哌拉西林的耐药率均＜30%，对庆大霉素和哌拉西林/三唑巴坦耐药率均＜20%，对阿米卡星的耐药率＜14%，对碳青霉烯类的耐药率为47.1%，碳青霉烯耐药菌株对其他抗菌药物的耐药率普遍高于碳青霉烯敏感菌株。结论 PA是该院感染的主要致病菌之一，PA对常用抗菌药物的耐药率总体上呈降低趋势，但部分抗菌药物的耐药率始终高于全国平均水平，应予以高度关注，我院应积极防控院内感染，加强细菌耐药监测，避免耐药菌在院内流行。

Distribution and drug resistance trend analysis of Pseudomonas aeruginosafrom 2015 to 2018

Objective To understand the distribution characteristics and drug resistance characteristics of clinically isolated Pseudomonas aeruginosa (PA), to provide reference for rational use of antimicrobial agents in clinic. Methods PA strains isolated from clinical specimens in a hospital from January 2015 to December 2018 were collected, and the strain identification and antimicrobial susceptibility tests were conducted with automatic microbial identification instrument. The data were analyzed by WHONET5.6 software and SPSS22.0 statistical software. Results A total of 2,251 strains of PA were isolated in four years, and the proportion of PA in all Gram-negative bacteria isolated annually was 15.46%, 13.72%, 14.14%, and 12.89%. The majority of PA were isolated from respiratory tract specimens (76.50%), and were mainly isolated from ICU, respiratory, and rehabilitation. Antimicrobial susceptibility tests showed that the resistance rates of PA to aminotronam, imipenem, and melopenem were all larger than 30%, the resistance rate to cefoperazone/sulbactam was 21.6%~40%, the resistance rate to levofloxacin was 20.3%~32.5%, the resistance rate to ceftazidine, ciprofloxacin, cefepime, and piperacillin were all less than 30%, the resistance rate to gentamicin and piperacillin/tazobactam were all less than 20%, and the resistance rate to amikacin was less than 14%. The drug resistance rate of PA to carbapenems in our hospital was 47.1%, and the drug resistance rates of carbapene-resistant strains to other antibiotics were generally higher than those of carbapene-sensitive strains. Conclusion PA was one of the main pathogens of nosocomial infections in this hospital. The resistance rate of PA to commonly used antibacterial drugs showed a decreasing trend, but the resistance rates of PA to some antibacterial drugs were always higher than the national average level, which should be paid great attention to. The hospital should actively prevent and control infections in the hospital, strengthen the monitoring of bacterial resistance, to avoid the prevalence of drug-resistant bacteria in the hospital.