老年患者下呼吸道铜绿假单胞菌感染临床分布与耐药性分析

周毓，彭军，卢健聪，等.老年患者下呼吸道铜绿假单胞菌感染临床分布与耐药性分析[J].吉林医学,2014,35(10):2074-2077.

下呼吸道感染;铜绿假单胞菌;耐药性

周毓，彭军，卢健聪，钟浩海

广东省惠州市中心人民医院呼吸科，广东惠州516001

2014年

2074-2077.

知网,万方

目的：分析老年患者下呼吸道铜绿假单胞菌感染临床分布与耐药性。方法：搜集老年下呼吸道感染住院患者，分离培养出铜绿假单胞菌菌株痰标本156份，用VITEK2-Compact全自动细菌鉴定及药敏分析系统对临床标本中分离的156株铜绿假单胞菌进行鉴定，并采用琼脂扩散法进行体外药敏试验，依据CLSI最新折点判读结果。结果：非MDR铜绿假单胞菌临床分离株对头孢噻肟、磺胺甲唑/甲氧苄啶耐药性最高，耐药率达70%以上;对亚胺培南、美罗培南、氨曲南和头孢哌酮/舒巴坦、头孢他啶、哌拉西林/舒巴坦、阿米卡星的耐药率均在20%以内，其中亚胺培南、美罗培南敏感性均达到100%。而MDR菌株对哌拉西林、头孢噻肟、庆大霉素、环丙沙星、妥布霉素、磺胺甲唑/甲氧苄啶高度耐药，耐药率达100%，对哌拉西林/他唑巴坦、头孢吡肟、阿米卡星耐药性高达60%以上，对亚胺培南、美罗培南、氨曲南依旧敏感性较好，耐药性均低于20%。结论：亚胺培南、美罗培南对铜绿假单胞菌有较好的敏感性，可作为老年患者重症下呼吸道铜绿假单胞菌感染治疗的首选药物，如MDR铜绿假单胞菌感染，可联合用药。同时应当加强医院的抗生素合理使用，规范临床用药。 Objective To study the clinical distribution and drug resistance in patients with lower respiratory tract infection caused byPseudomonas aeruginosa.Method Elderly patients with lower respiratory tract infection were collected，156 sputum samples werr isolatedand cultured from sputum specimens of Pseudomonas aeruginosa，156 strains of Pseudomonas aeruginosa isolated from clinical specimens byVITEK2-Compact automatic bacteria identification and drug sensitivity were analyed，and the drug sensitivity test in vitro was done by agardiffusion method，according to CLSI latest break point，the results were gotten.Results Non MDR clinical isolates of pseudomonas aeruginosa to cefotaxime，sulfamethoxazole/trimethoprim resistance was the highest，resistance rate was more than 70%;to imipenem，meropenem，aztreonam and cefoperazone/shubatan，ceftazidime，piperacillin/sulbactam，Amikacin resistance rates were within 20%，imipenem andmeropenem sensitivity reached 100%.While the MDR strain to piperacillin，cefotaxime，ciprofloxacin，gentamicin，tobramycin，sulfamethoxazole/trimethoprim highly resistant，resistant rate was 100%，to piperacillin/tazobactam，cefepime，amikacin resistance up to 60%，toimipenem，meropenem，aztreonam was still good sensitivity，drug resistance was lower than 20%.Conclusion Imipenem and meropenemhave better sensitivity of pseudomonas aeruginosa，the drug of choice in patients with severe lower respiratory tract infection with pseudomonas aeruginosa treatment，such as MDR of pseudomonas aeruginosa infection，can be combined with medication.We should strengthen therational use of antibiotics in hospital and standardize clinical drug.。