2013-2015年安徽地区临床分离铜绿假单胞菌耐药性分析及体外联合药敏试验的研究

发布时间：2018-09-03 13:25

【摘要】：目的通过收集安徽省细菌耐药监测中心2013-2015年临床分离铜绿假单胞菌菌株,对其感染分布及耐药性情况进行分析,了解其耐药变迁情况。同时筛选出泛耐药铜绿假单胞菌,评价联合用药组的体外抑菌作用,寻求有效的联合抗菌药物。材料与来源菌株来源收集安徽省细菌耐药监测中心所属40家医院2013至2015年临床分离的铜绿假单胞菌(已去除来自同一患者相同部位的重复菌株)共829株。质控菌为铜绿假单胞菌ATCC27853,为安徽省细菌耐药监测中心保存菌株。方法1.收集2013-2015年安徽地区临床分离铜绿假单胞菌,按照2015CLSI标准,用琼脂倍比稀释法测定所收集菌株的MIC值,并运用WHONET 5.6软件分析细菌感染分布及耐药性等。2.筛选出PDRPA,运用棋盘法联合药敏试验进行体外抑菌实验,为临床药物的选择提供参考。结果1.安徽省细菌耐药监测中心2013年至2015年共收集临床分离铜绿假单胞菌829株,2013年-2015年分别为309株、232株、288株,占临床总分离革兰阴性菌比例为12.0%、14.4%、12.1%2.标本主要来自于痰液、脓液及分泌物、尿液、血液等多个部位。3.铜绿假单胞菌对阿米卡星、哌拉西林/他唑巴坦、头孢吡肟以及头孢他啶仍较为敏感且三年内耐药率较为稳定;对头孢唑肟等三代头孢耐药率显著升高;对环丙沙星耐药率有所下降;对于亚胺培南及美罗培南的耐药率基本持平。4.多粘菌素E+利福平、多粘菌素E+亚胺培南、多粘菌素E+头孢他啶、哌拉西林/他唑巴坦+阿米卡星、头孢他啶+环丙沙星五组抗菌药物对于泛耐药铜绿假单胞菌主要起到协同相加作用。结论1.铜绿假单胞菌感染仍占临床感染一定比例,泛耐药铜绿假单胞菌的不断检出表明抗生素耐药形势的严峻,为临床治疗增加了难度;2.多粘菌素等多种抗感染药物联合使用可作为对泛耐药铜绿假单胞菌感染的治疗方案。
[Abstract]:Objective to analyze the distribution of infection and drug resistance of Pseudomonas aeruginosa strains isolated from 2013 to 2015 in Anhui Provincial Monitoring Center for bacterial Resistance and to find out the changes of drug resistance of Pseudomonas aeruginosa strains. The pan-resistant Pseudomonas aeruginosa was screened to evaluate the bacteriostatic effect of the combined drug group in vitro and to seek effective combined antimicrobial agents. Materials and source strains 829 strains of Pseudomonas aeruginosa were collected from 40 hospitals of Anhui Province from 2013 to 2015. The quality control strain was Pseudomonas aeruginosa ATCC27853, which was preserved by Anhui Provincial Monitoring Center for bacterial Resistance. Method 1. The clinical isolates of Pseudomonas aeruginosa from 2013 to 2015 in Anhui province were collected. According to the 2015CLSI standard, the MIC values of the collected strains were determined by Agar doubling dilution method, and the distribution of bacterial infection and drug resistance were analyzed by WHONET 5.6 software. PDRPA, was selected to use chessboard method combined with drug sensitivity test for in vitro bacteriostasis test to provide a reference for the selection of clinical drugs. Result 1. From 2013 to 2015, 829 clinical isolates of Pseudomonas aeruginosa were collected in Anhui Provincial Monitoring Center for bacterial Resistance, and 309 strains of Pseudomonas aeruginosa were collected from 2013 to 2015, accounting for 288 strains of Pseudomonas aeruginosa, accounting for 12.0% of the total isolated Gram-negative bacteria. The specimens are mainly from sputum, pus and secretions, urine, blood and other parts. 3. Pseudomonas aeruginosa was still sensitive to amikacin, piperacillin / tazobactam, cefepime and ceftazidime, and the resistance rate to cefazoxime was stable in three years. The resistance rate of ciprofloxacin to ciprofloxacin decreased, and to imipenem and meropenem was almost equal. 4. Polymyxin E rifampicin, polymyxin E imipenem, polymyxin E ceftazidime, piperacillin / tazobactam amikacin, Ceftazidime ciprofloxacin five groups of antimicrobial agents for pan-resistant Pseudomonas aeruginosa play a synergistic role. Conclusion 1. Pseudomonas aeruginosa infection still accounted for a certain proportion of clinical infections. The continuous detection of pan-resistant Pseudomonas aeruginosa showed that the antibiotic resistance situation was severe, which increased the difficulty of clinical treatment. The combined use of polymyxin and other anti-infective drugs can be used as a treatment for pan-resistant Pseudomonas aeruginosa infection.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R446.5

【参考文献】