某院连续5年耐亚胺培南铜绿假单胞菌临床分布及其耐药性变迁

Clinical distribution and antimicrobial resistance changes of imipenem-resistant Pseudomonas aeruginosa in a hospital in 5 consecutive years

摘要:

目的 分析耐亚胺培南铜绿假单胞菌（IRPA）的分离情况和耐药性变化，为IRPA感染的预防和控制提供支持。 方法 回顾性统计2017年1月—2021年12月内蒙古自治区人民医院IRPA检出率、科室来源、标本来源、耐药率以及治疗常用抗菌药物用药频度（DDDs）值，并分析治疗常用抗菌药物DDDs值与铜绿假单胞菌耐药性的关系。 结果 2017—2021年4 170株铜绿假单胞菌中检出IRPA 1 114株，检出率为26.71%，各年度检出率分别为31.09%、30.05%、27.64%、26.66%、23.18%，呈逐年下降趋势（χ²=17.347，P < 0.001）。IRPA主要来源于干部保健病房科、重症监护病房（ICU）和呼吸内科，分别占54.76%、11.85%、8.26%；IRPA检出率最高的科室为ICU（44.30%）。IRPA主要分离自痰、尿和支气管肺泡灌洗液，分别为80.61%、5.92%、5.39%；IRPA检出率最高的标本类型为咽拭子（54.17%）。IRPA对哌拉西林、哌拉西林/他唑巴坦、头孢他啶、阿米卡星、庆大霉素、妥布霉素、左氧氟沙星、美罗培南和环丙沙星的耐药率均为先升后降；除美罗培南外，对其他检测抗菌药物的耐药率变化，差异均具有统计学意义（均P < 0.05）。2017—2021年IRPA对阿米卡星、庆大霉素和妥布霉素的耐药率较低，对其余7种抗菌药物都有较强程度的耐药，尤其对美罗培南耐药率>80%。总DDDs 2018年起逐年降低，5年中DDDs值在该院常用抗菌药物中居前三位的分别为头孢他啶、左氧氟沙星、庆大霉素，IRPA耐药率与常用抗菌药物DDDs值无线性相关（P>0.05）。 结论 IRPA主要分布于干部保健病房，标本来源以痰为主，5年中IRPA耐药性与常用抗菌药物DDDs无线性相关。IRPA耐药性有所控制，但依然较为严峻，医院应加强各项感染防控措施，有效控制IRPA的耐药和感染。

Abstract:

Objective To analyze the isolation and antimicrobial resistance of imipenem-resistant Pseudomonas aeruginosa (IRPA), and provide support for the prevention and control of IRPA infection. Methods Detection rate, department source, specimen source, antimicrobial resistance rate of IRPA and defined daily doses (DDDs) of commonly used antimicrobial agents in Inner Mongolia Autonomous Region People's Hospital from January 2017 to December 2021 were analyzed retrospectively. Relationship between DDDs value of commonly used antimicrobial agents and antimicrobial resistance of Pseudomonas aeruginosa (PA) was analyzed. Results From 2017 to 2021, 1 114 IRPA strains were detected from 4 170 PA strains, with a detection rate of 26.71%. The detection rates of each year were 31.09%, 30.05%, 27.64%, 26.66% and 23.18% respectively, showing a downward trend(χ²=17.347, P < 0.001). IRPA strains were mainly from cadre health care ward, intensive care unit (ICU) and respiratory department, accounting for 54.76%, 11.85% and 8.26%, respectively. The department with the highest IRPA detection rate was ICU (44.30%). IRPA was mainly isolated from sputum, urine and bronchoalveolar lavage fluid, accounting for 80.61%, 5.92% and 5.39%, respectively. Among the detected specimens, pharyngeal swab had the highest IRPA detection rate (54.17%). Resistance rates of IRPA to piperacillin, piperacillin/tazobactam, ceftazidime, amikacin, gentamicin, tobramycin, levofloxacin, meropenem and ciprofloxacin increased first, then decrease. Except meropenem, there was statistically significant difference in the change of antimicrobial resistance rate of other detected antimicrobial agents (all P < 0.05). From 2017 to 2021, IRPA had lower resistance rates to amikacin, gentamicin and tobramycin, and had higher resistance to the other 7 antimicrobial agents, especially to meropenem (above 80%). Total DDDs have been decreasing year by year since 2018. Within 5 years, the DDDs of ceftazidime, levofloxacin and gentamicin ranked among the top 3 commonly used antimicrobial agents in this hospital. There was no linear correlation between IRPA resistance rate and the DDDs of commonly used antimicrobial agents (P>0.05). Conclusion IRPA is mainly distributed in cadre health care ward, and sputum is the main specimen source. There was no linear correlation between IRPA resistance and the DDDs of commonly used antimicrobial agents within 5 years. Although antimicrobial resistance of IRPA has been controlled to a certain extent, it is still serious. Hospitals should strengthen various infection prevention and control measures to effectively control antimicrobial resistance and infection of IRPA.