2016~2022年昆明市临床分离铜绿假单胞菌耐药性变迁及交叉耐药表型分析  

Changes in Drug Resistance and Cross-resistance Phenotype Analysis of Pseudomonas aeruginosa Clinical Isolates from 2016 to 2022 in Kunming

作　　者：卢赞[1] 赵红燕[1] 李春付 李代碧 贺洋 尹利民 LU Zan;ZHAO Hongyan;LI Chunfu;LI Daibi;HE Yang;Yin Limin(Kunming First People’s Hospital/Ganmei Hospital Affiliated to Kunming Medical University,Kunming 650221,China)

机构地区：[1]昆明市第一人民医院/昆明医科大学附属甘美医院,昆明650221

出　　处：《现代检验医学杂志》2024年第6期189-194,共6页Journal of Modern Laboratory Medicine

基　　金：昆明市卫生健康委员会卫生科研项目(2022-11-01-022)。

摘　　要：目的了解该院七年来铜绿假单胞菌耐药率变化及耐药表型特征,为铜绿假单胞菌感染早期经验治疗提供依据,并为后期耐药机制研究奠定一定的基础。方法使用Whonet 5.6软件按年统计昆明市第一人民医院2016~2022年从临床标本分离并报告的铜绿假单胞菌药物敏感性数据,以亚胺培南、美罗培南、头孢他啶及头孢吡肟等药物为主要观察对象,统计并分析上述药物不同耐药性组合下其它抗生素耐药性情况。结果七年共检出铜绿假单胞菌1920株,其中多黏菌素耐药率最低为1%;阿米卡星、庆大霉素、妥布霉素平均耐药率分别为6.4%,8.6%,5.1%;喹诺酮类与哌拉西林/他唑巴坦、头孢他啶、头孢吡肟耐药率相似,在10%~20%之间;亚胺培南和美罗培南未显示出更优秀的敏感性,耐药率分别为21.3%和18.4%。各主要抗生素耐药率在七年间存在波动,多数自2017年上升,至2018年达峰值后回落,2020年后趋于平稳并与国内平均水平一致;亚胺培南敏感株1393株,该部分美罗培南敏感率为96.2%;美罗培南敏感株1451株,该部分亚胺培南敏感率为89%。亚胺培南、美罗培南均耐药共369株,该部分头孢他啶敏感率为33.1%。β-内酰胺类抗生素耐药种类越多,阿米卡星、环丙沙星敏感率越低。结论该院铜绿假单胞菌药物敏感性总体较好,应坚持严格的抗生素使用管理。氨基糖苷类可作为经验治疗首选药物,喹诺酮类次之,碳青霉烯类和头孢他啶亦为备选。该院铜绿假单胞菌对β-内酰胺类抗生素耐药机制呈多样性,碳青霉烯耐药株可由不同机制分别或共同介导。Objective To provide some evidence for early empirical treatment of infections caused by Pseudanonas aeruginosa(PA)and establish a certain foundation for further studies on its resistance mechanisms.Analyzed the resistance rate of PA and the phenotype characteristics for seven years at this hospital.Methods Using Whonet 5.6 software,the drug sensitivity data of PA isolated and reported from clinical specimens at Kunming First People’s Hospital from 2016 to 2022 were analyzed annually.Imipenem,meropenem,ceftazidime,and cefepime were the main observation objects,statisticaly analyze the resistance of other antibiotics under different drug resistance combinations of the above-mentioned drugs Results A total of 1920 strains of PA were detected in 7 years,with polymyxins exhibiting the lowest resistance rate at 1%.The average resistance rates for Amikacin,Gentamicin and Tobramycin were 6.4%,8.6%and 5.1%,respectively.The resistance rates of Quinolones,Piperacillin/Tazobactam,Ceftazidime,and Cefepime were similar,ranging from 10%~20%.Imipenem and Meropenem did not show better sensitivity,with resistance rates of 21.3%and 18.4%,respectively.The resistance rates of major antibiotics havefluctuated over the past 7 years,mostly increasing from 2017 to reaching a peak in 2018 and then falling back.And then stabilized with the domestic average level.1393 strains were sensitive to Imipenem,and the sensitivity rate of Meropenem in this part was 96.2%.1451 strains were sensitive to Imipenem,and 89%of them were sensitive to Meropenem at the same time.369 strains were both resistant to Imipenem and Meropenem,and 33.1%of them were sensitive to Ceftazidime.The more resistant toβ-lactam,the lower the sensitivity rate to Amikacin and Ciprofloxacin.Conclusion The overall drug sensitivity of PA in this hospital is relatively good.Should adhere to strict management of antibiotic use.Aminoglycosides can be the preferred drugs for empirical treatment,followed by Quinolones,and Carbapenems and Ceftazidime are also candidates.PA has dive

关 键 词：铜绿假单胞菌 耐药率 交叉耐药 耐药表型 

分 类 号：R378.991[医药卫生—病原生物学] R446.5[医药卫生—基础医学]