某大型教学医院2013—2015年铜绿假单胞菌的耐药性监测  

Surveillance of drug resistance of Pseudomonas aeruginosa in a major teaching hospital from 2013 to 2015

作　　者：王詝[1] 孙珊[1] 

机构地区：[1]重庆医科大学附属第一医院医学检验科,重庆400016

出　　处：《中国抗生素杂志》2017年第7期586-591,共6页Chinese Journal of Antibiotics

摘　　要：目的对2013—2015年我院临床标本中分离出的铜绿假单胞菌的耐药情况进行分析,以指导临床合理用药。方法对2013年1月—2015年12月我院临床送检标本进行常规分离培养,采用法国Bio Mérieux Vitek2 Compact系统和Vitek MS进行菌株鉴定,药物敏感性试验采用Vitek2 compact或者K-B法,用WHONET 5.6软件对药敏数据进行分析。结果 2013—2015年我院共分离2092株铜绿假单胞菌非重复菌株,每年均占所有分离菌株的10%左右,其中1230株来源于痰标本,占58.8%,其次为分泌物364株(17.4%)和尿224株(10.7%)。病区来源最高为呼吸病房,占17.0%,其次为重症医学科(12.3%)和神经外科(8.5%)。其中,黏液性铜绿假单胞菌的分离率每年依次为7.6%、9.4%和10.0%,呈逐年增加趋势。所有铜绿假单胞菌对常规测定药物的耐药率均低于30%,对亚胺培南的耐药率最高(25.4%),对阿米卡星的耐药率最低(9.0%),但是近3年多重耐药的铜绿假单胞菌分离率有所增加,逐年分别为10.7%、12.1%和13.1%。并且统计耐药性变迁时发现近3年美罗培南最低抑菌浓度(minimal inhibitory concentration,MIC)为16μg/m L的铜绿假单胞菌比例逐年增高(9.0%、13.2%和14.1%),环丙沙星MIC为4μg/m L的铜绿假单胞菌比例却逐年降低(20.1%、14.3%和13.6%)。结论我院铜绿假单胞菌的分离率近3年都比较稳定,但多重耐药菌分离率有增加趋势,特别是黏液型铜绿假单胞菌的分离率逐年增加更应引起临床重视。掌握我院铜绿假单胞菌的临床分布和耐药性变迁,可以为临床提供资料,更好地控制铜绿假单胞菌感染。Objective To analyze the distribution and drug sensitivity of Pseudomonas aeruginosa isolated from the First Affiliated Hospital of Chongqing Medical University from Jan 2013 to Jan 2015 and to guide the clinical rational use of drugs. Methods Bacterial identification and determination were performed by VITEK 2 Compact and VITEK MS. The minimal inhibitory concentration （MIC） were performed by VITEK 2 Compact and the K-B disk diffusion method. Statistical analysis was performed using WHONET 5.6 software. Results A total of 2,092 strains of Pseudomonas aeruginosa were isolated, accounting for about 10% of all isolates each year. Among them, 1,230 strains were isolated from sputum, accounting for 58.8%, 364 strains were isolated from secretion, accounting for 17.4%, and 224 strains were isolated from urine, accounting for 10.7%. The 2,092 strains of Pseudomonas aeruginosa were mainly distributed in the department of respiratory medicine （17.0%）, followed by intensive medicine （12.3%）, and neurosurgery （8.5%）. The isolation rates of mucoid Pseudomonas aeruginosa strains were 7.6%, 9.4%, and 10.0%, which increased year by year. The resistance rates to all antimicrobial agents were below 30%. These Pseudomonas aeruginosa were most resistant against imipenem with the resistance rate of 25.4%, and were most sensitive against amikacin with the resistance rate of 9.0%. In the recent three years, the isolation rates of the MDR- PAE strains accounted for 10.7%, 12.1% and 13.1%, which increased yearly. From 2013 to 2015, the strains with resistance against meropenem （MICs=16gg/mL） were 9.0%, 13.2% and 14.1%, which increased yearly. However, the strains with resistance against ciprofloxacin （MICs=4-tg/mL） were 20.1%, 14.3%, and 13.6%, which decreased over time. Conclusion The isolation rates ofPseudomonas aeruginosa were relatively stable, but the isolation rates of MDR-P. aeruginosa strains increased in the recent three years, particularly the mucoid Pseudomonas aeruginosa. Understanding of changes of

关 键 词：铜绿假单胞菌 耐药性 抗菌药物 

分 类 号：R978.1[医药卫生—药品]