标题：深圳地区三级区属医院铜绿假单胞菌感染分布及耐药性分析

      作者：施俊柱 1，刘爱胜 2，文 艳 3
    (1.深圳市龙华新区中心医院检验科，广东 深圳 518110；
2.深圳市龙华新区人民医院检验科，广东 深圳 518109；
3.深圳市光明新区人民医院 ICU，广东 深圳 518106)

      卷次： 2015年26卷16期

      【摘要】 目的 了解深圳市龙华新区和光明新区三家三级区属医院铜绿假单胞菌感染分布及耐药性，为科
学用药提供依据。方法 收集2013年6月至2014年11月三家三级区属医院各科住院临床标本共3 176份，采用
VITEK-32细菌鉴定仪进行细菌鉴定，药敏试验采用K-B法和微量肉汤稀释法(MIC法)，并对结果进行统计分
析。结果 3 176份标本中铜绿假单胞菌总分离率为 51.16% (1 625/3 176)，其中痰液标本为 52.8% (858/1 625)，
其次为支气管肺泡灌洗液和脓液，分别为20.1% (327/1 625)和16.7% (271/1 625)；ICU、神经外科和心胸外科铜绿
假单胞菌分离率分别为 41.6% (676/1 625)、15.9% (259/1625)和 19.1% (310/1 625)；碳青霉烯类敏感、耐碳青霉烯
类及泛耐药铜绿假单胞菌分离率分别为67.1% (1 090/1 625)、31.6% (514/1 625)和1.29% (21/1 625)；耐碳青霉烯
类铜绿假单胞菌对临床常用的15种抗菌药除了多黏菌素B外均比碳青霉烯类敏感的要严重，耐药率之间差异有
统计学意义(χ2=12.617~80.654，P<0.05)，2例耐碳青霉烯类铜绿假单胞菌对多黏菌素B出现耐药，除对阿米卡星、
庆大霉素、妥布霉素有较高的敏感性外，其余11种抗菌药物的耐药率均>60%以上。结论 铜绿假单胞菌分离率
较高，主要来自呼吸道标本和 ICU病区；耐碳青霉烯类铜绿假单胞菌耐药性比碳青霉烯敏感的要严重，应采取有
效的预防及合理使用抗菌药措施，杜绝耐碳青霉烯类和泛耐药铜绿假单胞菌的蔓延。

      【关键词】 铜绿假单胞菌；分离率；分布；耐药性

      【中图分类号】 R378.99+1 【文献标识码】 A 【文章编号】 1003—6350（2015）16—2397—03


Distribution of Pseudomonas aeruginosa infection and drug resistance analysis in third district hospitals in
Shenzhen.
SHI Jun-zhu 1, LIU Ai-sheng 2, WEN Yan 3. 1. Department of Clinical Laboratory, Shenzhen Longhua New
District Central Hospital, Shenzhen 518110, Guangdong, CHINA; 2. Department of Clinical Laboratory, Shenzhen
Longhua New District People's Hospital, Shenzhen 518109, Guangdong, CHINA; 3. ICU, Shenzhen Guangming New
District People's Hospital, Shenzhen 518106, Guangdong, CHINA

【Abstract】 Objective To investigate the distribution of Pseudomonas aeruginosa infection and drug resis-
tance in three hospitals in Longhua New District and Guangming New District of Shenzhen in order to provide the ba-
sis for scientific and medical treatment. Methods A total of 3 176 clinical specimens were collected from June 2013
to November 2014 in the three hospitals. VITEK-32 bacteria identification analyzer system was used for bacteria iden-
tification. K-B method and broth dilution method (minimum inhibitory concentration, MIC) were applied for drug sen-
sitive test. Results Among the 3 176 specimens, 1 625 strains of Pseudomonas aeruginosa were separated, and the total
separation rate of Pseudomonas aeruginosa was 51.16% (1 625/3 176), including 52.8% (858/1 625) sputum specimens,
followed by bronchoalveolar lavage [20.1% (327/1 625)] and pus [16.7% (271/1625)]. The separation rate of Pseudomo-
nas aeruginosa isolated from ICU, neurosurgery and thoracic surgeons were 41.6% (676/1 625), 15.9% (259/1 625) and
19.1% (310/1 625), respectively. The Pseudomonas aeruginosa sensitive to carbapenems, resistant to carbapenems,
and those with extensive drug resistance isolated accounted for 67.1% (1 090/1 625), 31.6% (514/1 625) and 1.29%
(21/1 625), respectively. The Pseudomonas aeruginosa resistant to carbapenems were more sensitive to 15 clinical com-
monly used antimicrobials than Pseudomonas aeruginosa sensitive to carbapenems, in addition to polymyxin B, and the
differences were statistically significant (χ2=12.617~80.654, P<0.05). Two cases of pseudomonas aeruginosa resistant to
carbapenems were found resistant to polymyxin B, and they were highly resistant to the 11 kinds of antimicrobial drugs
(>60%) in addition to amikacin, gentamycin, tobramycin. Conclusion The separation rate of Pseudomonas aeruginosa
is high, and the strains are mainly isolated from respiratory tract specimens and ICU ward. The drug resistance in carbap-
enems-resistant Pseudomonas aeruginosa is more serious than that in carbapenems-sensitive Pseudomonas aeruginosa.
Effective measures should be taken for prevention and rational use of antibacterial drugs, and to avoid the spread of car-
bapenems-sensitive Pseudomonas aeruginosa and the strains with extensive drug resistance.

      【Key words】 Pseudomonas aeruginosa; Separation rate; Distribution; Drug resistance
基金项目：深圳市龙华新区科技创新资金项目(编号：2013136)