华东医院感染老年患者多重耐药和广泛耐药革兰阴性杆菌的耐药性分析

摘要

目的：了解华东医院感染老年患者多重耐药和广泛耐药革兰阴性杆菌耐药性及其分布，为指导临床合理使用抗菌药物和有效预防、控制医院感染提供依据。方法收集华东医院60岁以上老年患者临床标本（痰液、血液、尿液、胆汁及伤口分泌物等）进行细菌培养、鉴定和体外药物敏感性试验；对228例多重耐药和42例广泛耐药革兰阴性杆菌感染的患者资料进行回顾性研究，并用聚合酶链反应（PCR）检测8株广泛耐药的鲍曼不动杆菌的相关耐药基因。结果多重耐药菌排名前3位的是鲍曼不动杆菌、铜绿假单胞菌和大肠埃希菌；广泛耐药菌排名前3位的是鲍曼不动杆菌、铜绿假单胞菌和洋葱伯克霍德菌。广泛耐药的鲍曼不动杆菌检测到了TEM、SHV、PER、ant（2″）－Ⅰ、ant（3″）－Ⅰ、ant（6′）－Ⅰb、OXA－23、gyrA 和 qacEΔ1基因，IMP、VIM 和 OXA－24基因检测为阴性。结论华东医院老年患者医院感染的鲍曼不动杆菌、铜绿假单胞菌耐药情况较为严重，呼吸科和重症监护病房尤其要加强抗菌药物的合理使用并进行细菌耐药性的监测等措施，有效预防、延缓和控制耐药菌株的产生和播散。%Objective To guide the reasonable antibiotic clinical use and provide the reference for effective prevention and nosocomial infection control by understanding the drug resistance and distribution in elder patients infected with multi-drug resistant and extensively-drug resistant Gram negative bacillus in Huadong Hospital.Methods The data of 228 elder patients infected with multi-drug resistant bacillus and 42 patients infected with extensively-drug resistant bacillus were studied retrospectively ( all the elder patients were over 60 years old).Bacterial culture, identification and drug susceptibility were performed for the specimens from patients ( sputum, blood, urine, bile, wounds secretion and so on).The resistant genes of 8 extensively-drug resistant Acinetobacter baumannii were determined by polymerase chain reaction(PCR).Results The rank of the multi-drug resistant bacillus was Acinetobacter baumannii, Pseudomonas aeruginosa and Escherichia coli, as well as the rank of the extensively-drug resistant bacillus was Acinetobacter baumannii, Pseudomonas aeruginosa and Burkholderia cepacia.The TEM, SHV, PER, ant (2″)-Ⅰ, ant(3″)-Ⅰ, ant(6′)-Ⅰb, OXA-23, gyrA and qacEΔ1 genes were detected in the extensively-drug resistant Acinetobacter baumannii.The results of IMP, VIM and OXA-24 genes were negative.Conclusions Since the severe drug resistance of Acinetobacter baumannii and Pseudomonas aeruginosa from elder patients in Huadong Hospital, especially in the department of respiration and intensive care unit, we should effectively prevent, delay and control the generation and spreading of resistant isolates by strengthening the reasonable antibiotic use as well as monitoring the resistant isolates.