耐亚胺培南铜绿假单胞菌的耐药性及危险因素分析

目的分析耐亚胺培南铜绿假单胞菌的耐药性及其产生的危险因素，为临床合理使用抗生素提供依据和探讨该耐药菌的防治方法。方法采用常规方法检测我院2003～2007年临床标本分离的耐亚胺培南铜绿假单胞菌的耐药性，并回顾性分析比较该菌感染患者在院内采取的各项措施、病情发展等危险因素。结果2003～2007年共分离出769株铜绿假单胞菌，其中195株是耐亚胺培南株，占25．3％，每年耐亚胺培南株的检出率依序分别为15．7％、11．9％、13．8％、24．1％、41．4％。耐亚胺培南铜绿假单胞菌对其它抗生素的耐药率最低的是多粘菌素E（0．2％），对氨基糖苷类的阿米卡星（46．1％）、庆大霉素（52．3％）和妥布霉素（52．6％）也相对较低。该菌感染单因素分析：入住ICU、使用广谱抗生素大于3周、住院时间超过4周、气管插管或气管切开、2周内接受碳青酶烯类治疗是耐亚胺培南铜绿假单胞菌感染的危险因素。结论耐药性铜绿假单胞菌逐年增多，合理使用抗菌药物、缩短患者ICU住院时间、增强机体免疫功能等，减少院内感染机会，有利于防止耐亚胺培南铜绿假单胞菌的产生。

Analysis of drug resistance of imipenem-resistant Pseudomonas aeruginosa and risk factors

Objective To understood drug resistance of imipenem - resistant Pseudomonas aeruginosa and the risk factors and provide evidence for rational use of antibiotics. Methods Conventional methods was used in analysis of drug resistnace of imipenem - resistant Pseudomonas aeruginosa isolated from clinial specimens in this hospital during the years of 2003 - 2007 and the risk factors were analyzed. Results From 2003 to 2007 a total of 769 strains of Pseudomonas aeruginosa were isolated including 195 imipenem - resistant strains （25.3%） The annual detection rates of imipenem - resistant strain were： 15.7% （ 15/95 ）, 11.9% （ 15/92）, 13.8% （ 17/123 ）, 24.1% （53/220）, 41.4% （99/239）. The resistance rates of imipenem - resistant Pseudomonas aeruginosa to polymyxin E, amikacin of aminoglycosides, gentamicin, tobramycin, 0.2%, 46.1%, 52.3%, 52. 6%. The risk factors were hospitalization in ICU, use of antiiotics with broad spectrum over three weeks, hospitalization over a period of 4 weeksendotracheal intubation or tracheotomy, etc. Conclusion Rational use of antibiotics, shortening the duration of hospitalization in ICU, enhancement of immunity, protection from infection are the measures effective for prevention of of imipenem - resistant Pseudomonas aeruginosa infection.