下呼吸道感染铜绿假单胞菌流行和耐药现状分析

目的总结下呼吸道感染住院患者铜绿假单胞菌的流行情况及耐药现状,为临床合理应用抗菌药物提供指导依据。方法收集2004年下呼吸道感染住院患者痰培养结果为铜绿假单胞菌的数据,用WHONET 5.3软件统计分析。结果患者痰标本中共检出铜绿假单胞菌152株,其中产ESBLs者20株,占13%。外科ICU和呼吸ICU铜绿假单胞菌所占比例最高,分别为25.5%和21.6%。呼吸ICU中铜绿假单胞菌产ESBLs菌株比例最高(36.3%)。铜绿假单胞菌除对哌拉西林/他唑巴坦敏感率较高为70.1%,对其他加酶抑制剂的β-内酰胺类、碳青霉烯类、氨基糖苷类、氟喹诺酮类和单环酰胺类敏感率都较低,大都低于50%。耐药分析组合结果显示:亚胺培南-哌拉西林/他唑巴坦(IPM-TZP)、阿米卡星-哌拉西林/他唑巴坦(AMK-TZP)、头孢他啶-哌拉西林/他唑巴坦(CAZ-TZP)、阿米卡星-亚胺培南(AMK-IPM)、环丙沙星-哌拉西林/他唑巴坦(CIP-TZP)2者均敏感率较高,在40%以上,且两者均耐药率较低,在20%左右。结论铜绿假单胞菌耐药现象较为严重,耐药机制较为复杂。通过对其目前耐药状况的研究,单一用药推荐哌拉西林/他唑巴坦(TZP),联合用药推荐IPM-TZP、AMK-TZP、CAZ-TZP、AMK-IPM、CIP-TZP。

ANALYSIS OF PSEUDOMONAS AERUGINOSA IN LOW RESPIRATORY TRACT INFECTION AND ITS DRUG RESISTANCE

Objective This study was to investigate the epidemic situation of Pseudomonas aeruginosa in low respiratory tract infection and its drug resistance,in order to provide guidelines for clinic therapy.Methods To collect and analyze the data of Pseudomonas aeruginosa from the sputum specimens of inpatients with low respiratory tract infection in 2004 with the software WHONET 5.3.Results 152 strains of Pseudomonas aeruginosa were isolated,which contained 20 ESBLs-producing isolates(13%).The most common Pseudomonas aeruginosa was in Surgical ICU(25.5%),and the second was in Respiratory ICU(21.6%).ESBLs-producing Pseudomonas aeruginosa in Respiratory ICU(36.3%) was the most common.The susceptibility of Pseudomonas aeruginosa to Piperacillin/Tazobactam(TZP) was higher(70.1%) than other drugs,such as Imipenem(IPM),Amikacin(AMK),Ciprofloxacin(CIP),Ceftazidime(CAZ) and Levofloxacin(LVX),lower than 50%.As to resistance profiles,there were higher ratios of both-susceptibility(all above 40%) and lower ratios of both-resistance(all around 20%) in the profile antibacterial,Imipenem-Piperacillin/Tazobactam(IPM-TZP),Amikacin-Piperacillin/Tazobactam(AMK-TZP),Ceftazidime-Piperacillin/Tazobactam(CAZ-TZP),Amikacin-Imipenem(AMK-IPM),Ciprofloxacin-Piperacillin/Tazobactam(CIP-TZP).Conclusion The drug-resistance mechanism of Pseudomonas aeruginosa is so complicated that many kinds of drugs prove poorly effective or ineffective.According to this research,TZP is recommended when single drug is utilized,and IPM-TZP,AMK-TZP,CAZ-TZP,AMK-IPM,CIP-TZP can be tried if single drug therapy fails.