摘要
目的 了解烧伤病房病原菌分布、铜绿假单胞菌耐药情况及常用抗革兰阴性杆菌药物使用情况，为指导经验用药提供依据。方法采集2007年1月-2012年12月笔者单位7441例患者的创面分泌物、导管表面附着物、血液、大便、尿液、痰液标本，行细菌培养，共分离出2758株菌株。州API细菌鉴定板条及全自动微生物鉴定及药敏分析系统鉴定菌株；采用K-B纸片扩散法，选择阿米卡譬、头孢他啶、头孢哌酮／舒巴坦等13种临床常用抗菌药物进行药物敏感试验；统计每年阿米卡星、头孢哌酮／舒巴坦、头孢他啶、亚胺培南、环丙沙星5种抗菌药物每千住院日规定日剂量频数作为其使州强度。采用WHONET5．6软件统计细菌分布情况及铜绿假单胞菌对13种抗菌药物的耐药情况；采用SPSS19．0统计软件对铜绿假单胞菌对13种抗菌药物耐药率变化与年份的关系，铜绿假单胞菌占检m菌比例与阿米卡星等5种常用抗革兰阴性杆菌药物使用强度的关系，以及环丙沙星使用强度与铜绿似单胞菌对阿米卡星、头孢哌酮／舒巴坦、亚胺培南耐药率变化的关系行Pearson相关分析。结果（1）6年中，金黄色葡萄球菌占检m菌比例（31％，865／2758）最高，但总体呈下降趋势。铜绿假单胞菌所占比例逐步上升且与鲍氏不动杆菌并列第2（总体均占17％，458／2758）。（2）6年问，铜绿似单胞菌对阿米卡星、庆大霉素、氨曲南、哌拉两林、头孢哌酮、头孢吡肟、哌拉西林／他唑巴坦、头孢哌酮／舒巴坦、亚胺培南、美罗培南的耐药率明显上升且与年份呈明显正相关（r值为0．844～0．988，P〈0．05或P〈0．01），而对环丙沙星的耐药率明显下降且与年份呈明显负相关（r=-0．836，P〈0．05）、，（3）6年问，阿米卡星（8．65～9J．44）、头孢哌酮／舒巴坦（9．62～63。56）、亚胺培南（7．63～157．25）、头孢他啶（18．39～86．11）、环丙沙星（0～19．77）的使用强度均有所上升。（4）铜绿假单胞菌占i检m菌比例与亚胺培南、环丙沙星的使用强度呈明显正相关（r值分别为0．849、0．933，P〈0．05或P〈0．01），与阿米卡星、头孢哌酮／舒巴坦、头孢他啶使用强度相关性不强（r值分别为0．672、0．668、0．794，P值均大于O．05）。（5）环丙沙星使用强度与铜绿假单胞菌对阿米卡星、头孢哌酮／舒巴坦、亚胺培南耐药率均呈明显正相关（r值分别为0．878、0．934、0．928，P〈0．05或P〈0．01）。结论笔者单位2007-2012年铜绿假单胞菌耐药情况比较严重，与抗菌药物使用强度相关，可通过阶段性减少阿米卡星、头孢哌酮／舒巴坦、亚胺培南的使用逐渐恢复菌株对它们的敏感性。
Objective To study the distribution characteristics of pathogens, the drug resistance of Pseudomon.as aeruginos~ （PA） , and the use of antibiotics against Gram negative bacilli （ GNB ） in burn wards, so as to provide a guide for future treatment. Methods A total of 2 758 strains of pathogens were isolated from specimens of wound excretion, venous catheter attachment, blood, stool, urine, and sputum from 7 441 patients hospitalized in our burn wards from January 2007 to December 2012. After being identi- fied by API strips and automatie microorganism identification and drug sensitivity analyzer, drug resistance of all the pathogens to 13 antibiotics commonly used in clinic, including amikaein, cefoperazone/sulbaetam, eeftazidime, etc. , was tested by K-B paper disk diffusion method. The defined daily doses per 1 000 pa- tient-day of 5 antibiotics including amikaein, cetbperazone/suibactam, ceflazidime, imipenem, and cipro- floxacin eaeh year was set as use intensity. The WHONET 5.6 software was used to analyze the distributionof pathogens and the drug resistance of PA to 13 antibiotics. The SPSS 19.0 software was used to analyze the relation between changes in drug-resistant rates of PA to 13 antibiotics and year, the relation between the proportion of PA in all the pathogens and the use intensity of 5 antibiotics commonly used against GNB, and the relation between the use intensity of ciprofloxacin and the change in drug-resistant rates of PA to amika- ein, eefoperazone/sulbactam, and imipenem with Pearson correlation analysis. Results （1） In 6 years, Staphylococcus aureus ranked the first with the highest proportion （31% , 865/2 758 ）. The proportion of PA increased to tie in with Acinetobacter baumannii （both accounting for 17% , 458/2 758） , both taking the second place. （2） Drug-resistant rates of PA to amikacin, gentamicin, aztreonam, piperacillin, cefopera- zone, cefepime, piperacillin/tazobactam, cefoperazone/sulbactam, imipenem, and meropenem were signifi- cantly increased and positively correlated with year （with r values from 0. 844 to 0. 988, P 〈 0.05 or P 〈 0.01 ） , while the drug-resistant rate of PA to ciprofloxacin was decreased and negatively correlated with year （ r = - 0. 836, P 〈 0.05 ）. （3） In 6 years, the use intensity of amikacin （ from 8.65 to 91.44）, cefopera- zone/sulbactam （from 9.62 to 63.56） , imipenem （from 7.63 to 157.25） , ceftazidime （from 18.39 to 86.11 ） , and ciprofloxacin （ from 0 to 19.77） was increased. （4） The proportion of PA in all the pathogens was positively correlated with the use intensity of imipenem and ciprofloxacin （with r values respectively 0. 849, 0. 933, P 〈 0.05 or P 〈 0.01 ） , while it was not significantly correlated with the use intensity of amikacin, cefoperazone/sulbactam, or ceftazidime （ with r values respectively 0. 672, 0. 668, 0. 794, P val- ues all above 0.05）. （5） The use intensity of ciprofloxacin was positively correlated with the drug-resistant rates of PA to amikacin, cefoperazone/sulbactam, and imipenem （ with r values respectively 0. 878, 0. 934, 0.928, P 〈0.05 orP 〈0.01）. Conclusions In our burn wards, drug-resistant PA was prevalent, with positive correlation with the use intensity of antibiotics. The sensitive rate can be increased by a decrease in the use of amikacin, cefoperazone/sulbactam, and imipenem periodically.
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2014年第1期9-14,共6页
Chinese Journal of Burns
关键词
烧伤
假单胞菌
铜绿
抗菌药
抗药性
Burns
Pseudomonas aeruginosa
Anti-bacterial agents
Drug resistance
