Saeed Muhammad, Rasheed Farhan, Afzal Raja Kamran, Hussain Shahida, Riaz Saba, Ahmad Adeel
Department of Pathology, Omar Hospital and Cardiac Centre, Lahore.
Department of Pathology, Allama Iqbal Medical College, Lahore.
J Coll Physicians Surg Pak. 2018 Apr;28(4):279-283. doi: 10.29271/jcpsp.2018.04.279.
To evaluate the pathogen burden and antibiotic-resistance trends of Pseudomonas aeruginosa among hospitalised patients at a tertiary care hospital.
Retrospective, hospital record-based, cross-sectional study.
Microbiology Laboratory, Allama Iqbal Medical College/Jinnah Hospital, Lahore, from January 2014 to December 2016.
A total of 5,960 samples were collected from clinically suspected cases of bacterial infections, admitted to the hospital. Microbial identification and antibiotic susceptibility pattern were carried out and analysed.
Out of a total of 5,960 samples, Pseudomonas aeruginosa was isolated from 1,268 (21.2%) specimens. Department-wise isolation rate was n=600 (42.9%), n=268 (15.4%), n=201 (12.6%), and n=199 (16.0%) from intensive care unit (ICU), surgical units, medical units, and Gynae wards, respectively (p<0.0001). Sample-wise isolation rate was, wound swabs n=448 (35%), urine n=356 (28%), sputum n=187 (14 %), tracheal aspirate n=127 (10%), blood n=99 (7%), and broncho-alveolar lavage n=51 (4%) (p<0.0001). Drug-resistance pattern showed low rates for carbapenems(meropenem n=440 (35%), Imipenem n=436 (34%) and beta-lactam + beta-lactamase inhibitor combination (piperacillin+tazobactam n=437 (34%) while alarming rates were observed for cephalosporins (ceftazidime n=716 (56%), fluoroquinolones (ciprofloxacin n=690 (54%), cefoperazone+sulbactam n=685 (54%), aminoglycosides (gentamicin, n=669 (53%), amikacin n=608 (48%), and monobactams (aztreonam n=666 (52%). Decreasing trend was observed only for amikacin 63% to 37%, aztreonam showed similar pattern throughout, while there was an increasing trend of drug resistance in all groups of antibiotics.
Emerging drug-resistant strains of Pseudomonas aeruginosa are probably linked to the injudicious use of antibiotics, leading to ineffective empirical therapy. Therefore, we suggest that culture and antimicrobial susceptibility testing should be done for targeted antimicrobial therapy against Pseudomonas aeruginosa.
评估一家三级护理医院住院患者中铜绿假单胞菌的病原体负荷及抗生素耐药趋势。
基于医院记录的回顾性横断面研究。
2014年1月至2016年12月，拉合尔市阿利亚玛·伊克巴尔医学院/真纳医院微生物实验室。
从医院收治的临床疑似细菌感染病例中总共采集了5960份样本。进行微生物鉴定及抗生素敏感性分析。
在总共5960份样本中，从1268份（21.2%）标本中分离出铜绿假单胞菌。按科室划分的分离率分别为：重症监护病房（ICU）n = 600（42.9%），外科科室n = 268（15.4%），内科科室n = 201（12.6%），妇科病房n = 199（16.0%）（p<0.0001）。按样本类型划分的分离率分别为：伤口拭子n = 448（占35%），尿液n = 356（占28%），痰液n = 187（占14%），气管吸出物n = 127（占10%），血液n = 99（占7%），支气管肺泡灌洗n = 51（占4%）（p<0.0001）。耐药模式显示碳青霉烯类药物耐药率较低（美罗培南n = 440（占35%），亚胺培南n = 436（占34%））以及β-内酰胺类+β-内酰胺酶抑制剂组合（哌拉西林/他唑巴坦n = 437（占34%）），而头孢菌素类（头孢他啶n = 716（占56%））、氟喹诺酮类（环丙沙星n = 690（占54%））、头孢哌酮/舒巴坦n = 685（占54%）、氨基糖苷类（庆大霉素n = 669（占53%），阿米卡星n = 608（占48%））以及单环β-内酰胺类（氨曲南n = 666（占52%））的耐药率令人担忧。仅阿米卡星呈现下降趋势，从63%降至37%，氨曲南在整个研究期间呈现类似模式，而所有抗生素组的耐药性均呈上升趋势。
铜绿假单胞菌新出现的耐药菌株可能与抗生素的不合理使用有关，导致经验性治疗无效。因此，我们建议针对铜绿假单胞菌进行培养及抗菌药物敏感性试验，以进行有针对性的抗菌治疗。
