摘要
目的了解铜绿假单胞菌(PAE)的耐药性变迁情况,分析其耐药性与抗菌药物使用量的关系,为临床合理使用抗菌药物提供参考。方法收集2010年1月至2014年12月从各种临床样本中分离的PAE 790株,采用纸片扩散法检测PAE对12种常用抗菌药物的敏感性,并统计抗菌药物的使用强度(AUD),用SPSS16.0软件分析数据间的相关性。结果近5年,PAE对哌拉西林-他唑巴坦的耐药率从2010年的33.1%下降到2014年的16.5%(P<0.05),美罗培南、亚胺培南从2010年的42.3%、39.6%下降到2014年的17.2%、19.0%(P<0.05),阿米卡星、庆大霉素从2010年的13.8%、39.9%下降到2014年的6.8%、17.1%(P<0.05)。多重耐药铜绿假单胞菌(MDRP)检出率呈下降趋势,以2011年的7.5%为最高。碳青霉烯耐药组PAE对其他多种抗菌药物的耐药性均高于碳青霉烯敏感组,且MDRP检出率也明显高于碳青霉烯敏感组(P<0.05)。普通病房与重症监护病房(ICU)MDRP的检出率无明显差异。MDRP对于哌拉西林-他唑巴坦的耐药率(39.5%)明显低于对亚胺培南和美罗培南的耐药率(分别为63.2%、68.4%,P<0.05)。碳青霉烯类药物的AUD与PAE的耐药率存在相关性(r=0.961,P<0.05)。结论 5年间PAE对哌拉西林-他唑巴坦、美罗培南、亚胺培南、阿米卡星、庆大霉素的耐药率呈下降趋势;哌拉西林-他唑巴坦可作为治疗MDRP的首选药物;碳青霉烯类药物使用量与PAE的耐药性有显著相关性。加强医院感染的防控以及抗菌药物的合理使用是减少MDRP产生的有效手段。
Objective To investigate the drug resistance of Pseudomonas aeruginosa(PAE) and thecorrelation between antibiotic usage and drug resistance,in order to provide a reference for clinical rational use ofantibiotics. Methods A total of 790 isolates of PAE were collected from January 2010 to December 2014. Kirby-Bauer method was performed for determining the drug susceptibility of PAE to 12 commonly-used antibiotics,andthe antibiotics use density(AUD) were counted. The correlation between drug resistance and AUD was analyzed bySPSS 16.0. Results In the past 5 years,the drug resistance rate of PAE to piperacillin-tazobactam decreased from33.1% in 2010 to 16.5% in 2014(P<0.05),those to meropenem and imipenem decreased from 42.3% and 39.6%in 2010 to 17.2% and 19.0% in 2014(P<0.05),and those to amikacin and gentamicin decreased from 13.8% and39.9% in 2010 to 6.8% and 17.1% in 2014(P<0.05). The determination rate of multi-drug resistance Pseudomonasaeruginosa(MDRP) was on the decline,and that in 2011(7.5%) was the highest. Carbapenem-resistant groupwas more frequently resistant to the other antibiotics than carbapenem-susceptible group,and the determination rateof MDRP was also higher(P< 0.05). There was no statistical significance in determination rates of MDRP betweenintensive care unit(ICU) and public wards. The drug resistance rate of MDRP to piperacillin-tazobactam(39.5%) was lower than those to imipenem(63.2%) and meropenem(68.4%)(P<0.05). A correlation was observedbetween AUD and PAE drug resistance rate(r=0.961,P<0.05). Conclusions The drug resistance rates of PAE topiperacillin-tazobactam,meropenem,imipenem,amikacin and gentamicin show a downside in the past 5 years,piperacillin-tazobactam could be used as a good choice for the treatment of MDRP. There is a correlation between PAEdrug resistance and carbapenem consumption. The prevention and control measures for nosocomial infection and therational use of antibiotics are effective means to reduce MDRP.
作者
舒文
钱颖
刘庆中
SHU Wen;QIAN Ying;LIU Qingzhong(Department of Clinical Laboratory,Shanghai First People's Hospital,Shanghai Jiaotong University,Shanghai 201620,China)
出处
《检验医学》
CAS
2016年第12期1055-1060,共6页
Laboratory Medicine
基金
国家自然科学基金项目(81371872)
关键词
铜绿假单胞菌
耐药性
抗菌药物
多重耐药
使用强度
Pseudomonas aeruginosa
Drug resistance
Antibiotics
Multi-drug resistance
Antibiotics use density
