深圳地区嗜麦芽窄食单胞菌医院感染及耐药性分析

Hospital Acquired Infection and Resistance of Stenotrophomonas Maltophilia

目的了解嗜麦芽窄食单胞菌引起医院感染的特点以及对抗生素的耐药性的变化趋势.方法对2001～2004年分离出的224株嗜麦芽窄食单胞菌选用19种抗生素进行药敏实验,按NCCLS标准判断.结果224株嗜麦芽窄食单胞菌的标本来源以痰标本为主,占76.8%,其次为腹水和血液;其临床分布以ICU(64株,29%)和呼吸科(61株,27%)为主.224株嗜麦芽窄食单胞菌对复方新诺明、环丙沙星、氯霉素的耐药率较低,分别为12.4%、19.5%和25.7%,但耐药率呈逐年上升趋势;其对氨苄西林、哌拉西林、哌拉西林/他唑巴坦、头孢西丁、氨苄西林/舒巴坦、庆大霉素、阿米卡星、亚胺培南、美罗培南、氨曲南和头孢菌素高度耐药,但对哌拉西林、哌拉西林/他唑巴坦、阿米卡星、头孢他啶、头孢吡肟的耐药率呈逐年下降趋势.各病区的感染菌株对部分抗菌药物的耐药性差异有显著性(P＜0.05).结论对嗜麦芽窄食单胞菌引起感染的经验治疗,可选用复方新诺明、环丙沙星或氯霉素.了解嗜麦芽窄食单胞菌的耐药现状,有利于为临床合理用药提供依据.

Objective To explore the trend of hospital acquired infection caused by Stenotrophomonas maltophilia and the resistance to 8ntibiotics. Methods Drug resistance test was performed on 224 strains of Stenotrophomonas maltophilia and drug sensitive experiments with 19 ordinary antibiotics were performed based on the standard of the NCCLS from 2001 through 2004. Results Most of the 224 strains were isolated from the sputum（76.8 % ）, and followed by isolations from the ascitic peritoneal fluid and blood. Most of the 224 strains were isolated from ICU（29% ） and department of respiratory diseases （27%）. The resistance rates of trimethoprim/sulfamethoxazole, ciprofloxacin and chloramphenicol were lower than that of the others drugs and were 12.4%, 19.5% and 25.7% respectively, but the drug resistance appeared to have an in- crease trend. Stenotrophomonas maltophtlia was highly resistant to ampicillin, piperacillin, piperacillin/tazobactam, cefoxitin, ampicillin/sulbactam, gentamicin, amikacin, imipenem, meropenem, aztreonam and cephalosporin; but the resistance rates of piperacillin, piperactllin/tazobactam, amikacin and ceftazidime appeared to have a decrease trend. The antimicrobial re- sistance of strains Isolated from different wards showed significant difference （P〈 0.05）. Conclusion Trimethoprim/sulfa- methoxazole, ciprofloxacln and chlorarnphenicol are relatively effective drugs in treatment of Stenotrophomonas maltophilia in- fection. The status of drug resistance In Stenotrophomonas maltophilia infections must be investigated to provide evidence for rational drug selection decision.