目的 分析我院儿科重症监护病房( PICU)分离出的铜绿假单胞菌(pseudomonas aenginosa,PA)的药敏情况,为临床的合理、有效治疗提供依据. 方法 分析2007年1月1日至2011年12月31 日,我院PICU铜绿假单胞菌培养阳性患儿的年龄分布,转归,菌株来源,药敏分析.总结2010至2011年,我院病原菌分布情况.采用纸片扩散法(K-B法)和微量肉汤稀释法进行体外药敏试验.结果 75例培养阳性.＜6个月26例(34.7％),2岁以下共49例( 65.4％).不同年龄组铜绿假单胞菌培养阳性性患儿占同期患儿总数百分比基本相同.死亡18例(24.0％).2010至201 1年,分离出的铜绿假单胞菌占C-菌10.9％,占细菌总数6.5％.126株PA 83株(65.9％)来自痰培养,31株(24.6％)来自气管插管导管培养,10株(7.9％)来自血培养,2株(1.6％)来自分泌物培养.对儿科临床常用治疗PA的抗生素敏感性:头孢哌酮/舒巴坦(72.4％),美罗培南(71.5％),亚胺培南(48.4％),头孢他啶(66.7％),哌拉西林/他唑巴坦(49.2％).对氨苄西林、头孢唑啉、头孢呋辛及头孢噻肟百分之百耐药.多重耐药依然严重,动态观察有下降趋势,2007年为90.5％,2008年为81.3％,2009年为51.1％,2010年为53.8％,2011年为33.3％.不同年度泛耐药情况变化不大,2008年为12.5％,2009年为2.2％,2010年为7.7％,2011年为6.7％.结论 铜绿假单胞菌耐药形势依然严峻,临床要防止滥用抗生素,以免加重耐药性产生.不断提高实验室检验技术,对PA感染要根据当地的用药经验及药敏结果合理应用敏感抗生素,必要时联合用药,提高治愈率.医护人员要注意手卫生,严格无菌揲作,防止医源性交叉感染.%Objective Pseudomonas aeruginosa is an important cause of nosocomial infection,severe sepsis and death which associated with a trends of rising rates of resistance to a broad array of antimicrobial agents.To explore a feasible treatment protocol for such patients,we analvzed the susceptibility patterns of Pseudomonas aeruginosa in pediatric intensive care unit (PICU). Method The age distribution,outcome of patients,sources of strains and susceptibility patterns of Pseudomonas aeruginosa in PICU from Jan 1,2007 to Dec 31,2011 were analyzed.Susceptibility to amikacin,piperacillin/tazobactam,aztreonam, ampicillin, ciprofloxacin, imipenem, meropenem, cefepime, cefoperazone, cefotaxime,ceftriaxone,ceftazidime,cefoperazone/sulbactam,cephazolin,cefuroxime,and polymyxin were determined by the disk-diffusion technique (K-B test method) and broth microdilution.P.aeruginosa ATCC 27853 was used as reference strain.Result Seventy-five patients were Pseudomonas aeruginosa positive.26(34.7％ ) were ＜ 6 m,49 ( 65.4％ ) were ＜ 2 y.The percentages of cases who were Pseudomonas aerugiosa positive in different age groups in the same time was basically similar; 18 (24.0％) cases died. Pseudomonas aeruginosa accounted for 10.9％ of G- germs s,6.5％ of all pathogens in 2010-2011.Of the 126 strains,83(65.9％) were from sputum sample,31 (24.6％ ) were from catheter sample of tracheal eannula, 10 (7.9％) were from blood sample and 2( 1.6％ )were from secretion sample.The sensitivity to antibiotics of Pseudomonas aeruginosa in pediatric common treatments was 72.4％ to cefoperazone/sulbaetam,71.5％ to meropenem,48.4％ to imipenem,66.7％ to ceftazidime,49.2％ to piperacillin/tazobactam1. Absolute resistance to ampicillin,cephazolin,cefuroxime and cefotaxime. Multiple-drug resistance was still severe,but a decreasing tendency was observed,90.5％ in 2007,81.3％ in 2008,51.1％ in 2009,53.8％ in2010,33.3％ in 2011.Pan-drug resistance in different years was similar,12.5％ in 2008,2.2％ in 2009,7.7％ in 2010,6.7％ in 2011. Conclusion The condition of drug resistance of Pseudomonas aeruginosa was still rigorous, we should conduct surveillance and prevent abusing antibiotics in order to avoid exacerbating drug resistance. We should improve testiug technique, early and appropriate empirical antibiotics therapy is crucial according to clinical experience and antibiotic sensitivity. The effective treatmeut of P.aeruginosa is paramount to prevent multidrug resistance.The use of combination therapies for P. aeruginosa infection has been a long-advocated practice. To prevent hospital acquired cross infection,health care workers must pay close attention to hand sanitation and sterile operation strictly.
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