医源性肺部感染患者耐碳青霉烯类铜绿假单胞菌及鲍氏不动杆菌的耐药机制分析

发布时间：2018-05-03 01:20

本文选题：医源性感染 + 耐碳青霉烯类铜绿假单胞菌　；参考：《中华医院感染学杂志》2017年11期

【摘要】：目的探讨耐碳青霉烯类铜绿假单胞菌(CRPA)及耐碳青霉烯类鲍氏不动杆菌(CRAB)的耐药机制,为指导临床合理选择抗菌药物提供治疗依据。方法回顾性调查2014年1月-2015年12月医院肺部感染住院患者送检的各类标本中检出病原菌577株,采用改良Hodge方法测定碳青霉烯酶表型,采用B-last方法测定超广谱β-内酰胺酶,分析CRPA及CRAB的耐药性及检出率的相关性。结果铜绿假单胞菌对亚胺培南、美罗培南的耐药率为32.95%和29.55%,而对阿米卡星的耐药率为5.11%,对磺胺甲恶唑/甲氧苄啶100.00%耐药;鲍氏不动杆菌对亚胺培南和美罗培南的耐药率均为47.75%,而对氨曲南100.00%耐药;176株PAE检出CRPA 31株,检出率17.61%,检出耐亚胺培南PAE 17株,检出率54.84%,检出耐美罗培南PAE 14株,检出率45.16%;178株ABA检出CRAB 39株,检出率21.91%,检出耐亚胺培南ABA 22株,检出率56.41%,检出耐美罗培南ABA 17株,检出率43.59%。结论医源性感染患者CRPA及CRAB的耐药率呈逐年增加,临床医师应根据细菌鉴定和药敏结果正确合理使用抗菌药物,以便提高疗效和减少耐药菌株的发生。
[Abstract]:Objective to explore the drug resistance mechanism of carbapenem-resistant Pseudomonas aeruginosa (CRPA) and carbapenem-resistant Acinetobacter baumannii (CRA) and to provide therapeutic basis for clinical rational selection of antimicrobial agents. Methods from January 2014 to December 2015, 577 strains of pathogenic bacteria were detected from hospitalized patients with pulmonary infection. The phenotypes of carbapenem were determined by modified Hodge method, and extended spectrum 尾 -lactamases were determined by B-last method. To analyze the correlation between drug resistance and detection rate of CRPA and CRAB. Results the resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 32.95% and 29.55%, while those to amikacin were 5.11% and 100.00% to sulfamethoxazole / trimethoprim. The resistant rates of Acinetobacter baumannii to imipenem and meropenem were 47.75, while to amtreonam 100.00%, CRPA 31 strains were detected in PAE, the detectable rate was 17.61%, 17 strains of imipenem resistant PAE were detected, the detection rate was 54.84%, and 14 strains of meropenem PAE were detected. 39 strains of CRAB were detected in 45.16 strains of ABA, 21.91 strains were detected, 22 strains of imipenem resistant ABA were detected, the detectable rate was 56.41%, and 17 strains of meropenem ABA were detected, the detection rate was 43.59%. Conclusion the drug resistance rates of CRPA and CRAB in iatrogenic infection patients are increasing year by year. The clinicians should use antibiotics correctly and reasonably according to the results of bacterial identification and drug sensitivity in order to improve the efficacy and reduce the occurrence of drug-resistant strains.
【作者单位】：河南科技大学临床医学院河南科技大学第一附属医院药剂科;青岛大学医院药剂科;青岛大学附属医院检验科;河南大学淮河医院神经内科;
【基金】：河南科技攻关基金资助项目(112102310090)
【分类号】：R563.1

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