某综合性医院铜绿假单胞菌感染特点及耐药变迁

王丽; 崔琢; 郭普; 张向君; 朱敬蕊

doi:10.16766/j.cnki.issn.1674-4152.003154

某综合性医院铜绿假单胞菌感染特点及耐药变迁

doi: 10.16766/j.cnki.issn.1674-4152.003154

王丽^1, ,,
崔琢¹,
郭普²,
张向君¹,
朱敬蕊¹

1.
蚌埠医学院第一附属医院医院感染管理科，安徽蚌埠 233004
2.
蚌埠医学院第一附属医院检验科，安徽蚌埠 233004

基金项目:

安徽省高校自然科学研究项目 KJ2021A0761

蚌埠医学院科技项目人文社会科学重点项目，2021byzd278sk

详细信息

通讯作者:
王丽，E-mail：wl129611@sina.com

中图分类号: R372 R378.991
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- 被引次数: 0
出版历程
- 收稿日期: 2022-10-09
- 网络出版日期: 2023-10-19

Characteristics and drug resistance of Pseudomonas aeruginosa infection in a general hospital

1.
Department of Hospital Infection Management, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的研究医院铜绿假单胞菌感染的临床分布特点及耐药性变迁，为医院感染防控和合理使用抗菌药物提供依据。方法通过检索电子病历系统和医院感染实时监测系统调查病例资料，查阅2019年1月—2021年12月某综合性医院住院患者的铜绿假单胞菌感染分布和耐药情况，应用Whonet 5.6软件和SPSS 25.0统计学软件对相关资料进行统计学分析。结果 2019—2021年该院住院患者中共检出非重复铜绿假单胞菌1 106株，以重症监护病房检出率最高(25.68%)，其次是急诊科(9.22%)和呼吸内科(8.23%)。在送检的各类标本中呼吸道标本的检出率占63.02%，其次是脓液(9.40%)、尿液标本(3.44%)。检出的铜绿假单胞菌对临床常用抗菌药物出现不同程度耐药，其中耐药率最高的是环丙沙星(37.79%)，耐药率最低的是阿米卡星(18.90%)。连续3年对亚胺培南、环丙沙星的耐药率均超过30%。对头孢吡肟、氨曲南、妥布霉素、庆大霉素、阿米卡星的耐药率呈下降趋势，3年间耐药率差异均有统计学意义(均P < 0.05)。3年间左氧氟沙星和环丙沙星的耐药率波动差异有统计学意义(P < 0.05)。结论该医院铜绿假单胞菌感染主要分布在重症监护病房，以呼吸道感染为主，3年间对临床常用抗菌药物耐药率呈现不同的趋势变化，耐碳青霉烯类铜绿假单胞菌菌株依然是临床关注的重点之一。在今后临床工作中需要持续监测铜绿假单胞菌流行情况和耐药性变迁，以提供有效的感染防控依据。
- 铜绿假单胞菌 /
- 医院感染 /
- 临床分布 /
- 耐药性
Abstract: Objective To study the clinical distribution characteristics and drug resistance changes of Pseudomonas aeruginosa infection in hospital, so as to provide basis for prevention and control of hospital infection and rational use of antibacterial drugs. Methods The distribution and drug resistance of Pseudomonas aeruginosa in hospitalized patients from January 2019 to December 2021 were searched by electronic medical record system and hospital infection real-time monitoring system. The relevant data were statistically analyzed by Whonet 5.6 software and SPSS 25.0. Results A total of 1 106 strains of non-duplicated Pseudomonas aeruginosa were detected in hospitalized patients from 2019 to 2021, with the highest detection rate in intensive care units (25.68%), followed by emergency departments (9.22%) and respiratory departments (8.23%). Among all kinds of samples submitted for examination, respiratory tract samples accounted for 63.02%, followed by pus (9.40%) and urine samples (3.44%). The detected Pseudomonas aeruginosa showed different degrees of resistance to commonly used clinical antimicrobials, with the highest resistance rate being ciprofloxacin (37.79%) and the lowest resistance rate being amikacin (18.90%). The resistance rate to imipenem and ciprofloxacin exceeded 30% for 3 consecutive years. The resistance rates to cefepime, aztreonam, tobramycin, gentamicin and amikacin showed a downward trend, and the differences in resistance rates during the three years were statistically significant (all P < 0.05). The fluctuation of levofloxacin and ciprofloxacin resistance rate during three years was statistically different (P < 0.05). Conclusion The infection of Pseudomonas aeruginosa is mainly distributed in the intensive care unit, mainly respiratory tract infection, and the resistance rate to common clinical antibiotics shows different trends in the past 3 years. Carbapenem-resistant Pseudomonas aeruginosa strains are still one of the focuses of clinical attention. In the future clinical work, it is necessary to continuously monitor the prevalence and drug resistance of Pseudomonas aeruginosa in order to provide effective basis for infection prevention and control.
- Pseudomonas aeruginosa /
- Nosocomial infection /
- Clinical distribution /
- Drug resistance

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表 1 2019—2021年某院临床分离铜绿假单胞菌检出情况

Table 1. Detection of clinical isolates of Pseudomonas aeruginosa from 2019 to 2021

年份	革兰氏阴性菌株数	PA株数	构成比 (%)	多重耐药 PA株数	构成比 (%)
2019	2 877	382	13.28	162	42.41
2020	2 968	329	11.08	120	36.47
2021	3 285	395	12.02	154	38.99
合计	9 130	1 106	12.11	436	39.42

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表 2 2019—2021年某院临床分离铜绿假单胞菌科室分布情况[株(%)]

Table 2. Distribution of clinical isolates of Pseudomonas aeruginosa from 2019 to 2021[plant (%)]

科室	2019年	2020年	2021年	合计
重症监护病房	102(26.70)	74(22.49)	108(27.34)	284(25.68)
急诊科	39(10.21)	24(7.29)	39(9.87)	102(9.22)
呼吸内科	37(9.69)	22(6.69)	32(8.10)	91(8.23)
神经外科	27(7.07)	32(9.73)	31(7.85)	90(8.14)
骨科	29(7.59)	28(8.51)	25(6.33)	82(7.41)
肿瘤科	15(3.93)	21(6.38)	39(9.87)	75(6.78)
整形烧伤科	30(7.85)	22(6.69)	17(4.30)	69(6.24)
老年病科	15(3.93)	18(5.47)	15(3.80)	48(4.34)
其他科室	88(23.03)	88(26.75)	89(22.54)	265(23.96)
合计	382(100.00)	329(100.00)	395(100.00)	1 106(100.00)

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表 3 2019—2021年某院临床分离铜绿假单胞菌标本分布情况[株(%)]

Table 3. Distribution of clinical isolates of Pseudomonas aeruginosa from 2019 to 2021[plant (%)]

标本来源	2019年	2020年	2021年	合计
痰液	256(67.02)	187(56.84)	254(64.30)	697(63.02)
脓液	61(15.97)	21(6.38)	22(5.57)	104(9.40)
尿液	6(1.57)	14(4.26)	18(4.56)	38(3.44)
血液	14(3.66)	11(3.34)	0	25(2.26)
粪便	1(0.26)	2(0.61)	1(0.25)	4(0.36)
腹水	8(2.09)	5(1.52)	8(2.03)	21(1.90)
胸水	2(0.52)	3(0.91)	0	5(0.45)
胆汁	0	0	4(1.01)	4(0.36)
其他	34(8.91)	86(26.14)	88(22.28)	208(18.81)
合计	382(100.00)	329(100.00)	395(100.00)	1 106(100.00)

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表 4 2019—2021年某院分离铜绿假单胞菌对常见抗菌药物的耐药情况[株(%)]

Table 4. Resistance of Pseudomonas aeruginosa to common antibiotics isolated from 2019 to 2021 [plant (%)]

抗菌药物	2019年耐药株 (n=382株)	2020年耐药株 (n=329株)	2021年耐药株 (n=395株)	合计	χ²值	P值
哌拉西林他唑巴坦	101(26.44)	88(26.75)	98(24.81)	287(25.95)	0.424	0.809
头孢他啶	119(31.15)	87(26.44)	116(29.37)	322(29.11)	1.918	0.383
头孢吡肟	106(27.75)	64(19.45)	86(21.77)	256(23.15)	7.491	0.024
氨曲南	152(39.79)	73(22.19)	119(30.13)	344(31.10)	25.831	< 0.001
亚胺培南	146(38.22)	113(34.35)	127(32.15)	386(34.90)	3.210	0.201
妥布霉素	150(39.27)	111(33.74)	95(24.05)	356(32.19)	21.116	< 0.001
庆大霉素	143(37.43)	115(34.95)	99(25.06)	357(32.28)	15.131	0.001
阿米卡星	92(24.08)	55(16.72)	62(15.70)	209(18.90)	10.366	0.006
左氧氟沙星	96(25.13)	141(42.86)	124(31.39)	361(32.64)	25.697	< 0.001
环丙沙星	121(31.68)	156(47.42)	141(35.70)	418(37.79)	19.779	< 0.001

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