安徽地区铜绿假单胞菌耐药性分析及泛耐药菌体外联合药敏试验的研究

摘要

目的 收集安徽省细菌耐药中心临床分离铜绿假单胞菌(PAE)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,并筛选出泛耐药铜绿假单胞菌(PDR-PA),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.方法 采用琼脂稀释法测定所收集PAE菌株的最低抑菌浓度(MIC)值.按照2015年美国临床实验委员会指导原则的标准计算抗菌药物的耐药率、中介率和敏感率,进一步采用棋盘法设计,琼脂平板稀释法测定所筛选出的54株PDRPA菌株的MIC,并计算部分抑菌浓度.结果 PAE对阿米卡星、哌拉西林/他唑巴坦、头孢吡肟以及头孢他啶最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(P＜0.05),对环丙沙星耐药率有所下降(P＜0.05),对于亚胺培南及美罗培南的耐药率基本持平.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5组抗菌药物对于PDRPA主要起到协同相加作用.结论 PAE感染仍占临床感染一定比例,应继续加强对PAE耐药性的监测,多粘菌素等多种抗感染药物联合使用可作为对PDRPA感染的治疗方案.%Objective To investigate the distribution and antimicrobial resistance of Pseudomonas aeruginosa infection in Anhui Province,and collect all the pan-drug resistant Pseudomonas aeruginosa (PDRPA) using the microtiter plate chequerboard assay as a test in vitro bacteriostasis experiment,which providing reference for the choice of clinical medicine.Methods Minimal inhibitory concentration of Pseudomonas aeruginosa strains were tested by using agar dilution method.The resistance rate,the medium rate and the sensitivity rate of the antimicrobial agents were calculated according to the guidelines of the American Clinical Laboratory Committee guidelines.Picking out PDRPA,using the method of board joint drug susceptibility test in vitro bacteriostasis experiment,provide reference for the choice of clinical medicine.Results The resistances of PAE to amikacin,piperacillin/tazobactam,cefepime and ceftazidime were sensitive and stable;the resistances to ceftizoxime were significantly increased (P ＜ 0.05);the resistance to ciprofloxacin was decreased to some point(P ＜ 0.05);the resistances to imipenem and meropenem were stable.Polymyxin E + rifampicin,polymyxin E + imipenem,polymyxin E + cephalosporins,piperacillin/ tazobactam + amikacin,cephalosporins + ciprofloxacin,5 groups of antimicrobial agents for PDR pseudomonas aeruginosa major synergy together.Conclusion Pseudomonas aeruginosa infection is still a certain proportion of clinical infection.Thus,it is necessary to strengthen the surveillance of prevalence of PAE drug resistance so as to provide a reference for clinical therapy.The polymyxin E and other anti-infective drug combination can be used as the generic drug resistance of Pseudomonas aeruginosa infection treatment.