下呼吸道非发酵菌的分布及其耐药性研究

Distribution and drug resistance analysis of nonfermenter in lower respiratory tract

目的了解2000～2003年安微医科大学第一附属医院下呼吸道非发酵菌的分布及其耐药性,为临床合理选用抗生素提供依据。方法细菌鉴定、药敏试验和诱导β内酰胺酶(IB)检测采用WalkAway40全自动微生物分析仪,超广谱β内酰胺酶(ESBLs)检测采用纸片确证试验。结果2000～2003年下呼吸道非发酵菌的检出率为282%。其构成以铜绿假单胞菌为最多(566%),其次为洛菲不动杆菌(93%)、嗜麦芽窄食单胞菌(86%)和鲍曼或溶血不动杆菌(85%)。对复方新诺明,嗜麦芽窄食单胞菌的耐药率最低(143%)。对头孢他啶、亚胺培南、哌拉西林或他巴坦,铜绿假单胞菌的耐药性较低,分别为203%、208%和283%;洛菲不动杆菌耐药率比鲍曼或溶血不动杆菌普遍偏低。铜绿假单胞菌ESBLs和IB的检出率分别为157%和842%。结论下呼吸道非发酵菌的检出率较高,主要为铜绿假单胞菌。非发酵菌耐药现象严重,不同非发酵菌的耐药谱差异较大。铜绿假单胞菌IB发生率高。

Objective To investigate the distrubution of the nonfermenter(NF) and the change of its resistance in lower respiratory tract in our hospital in 2000～2003,instruct clinical application of antibiotics reasonably. Methods The bacteria strains and antibiotic susceptibility of bacteria and inducible beta-lactamase (IB) were determined by MicroScan WalkAway-40.Extended spectrum beta-lactamases(ESBLs) was confirmed by NCCLS.Results The rate of the NF was 28.2% in lower respiratory tract in 2000～2003.Pseudomonas aeruginosa(PA)?Acinetobacter lwoffii?Xanthomonas maltophilia(X.maltophilia) and Acinetobacter baumann/Haemolyticus were accounted for 56.6%,9.3%,8.6% and 8.5% .The drug resistance rates of sulfamethoxazole/trimethoprim to X.maltophilia was lowest (14.3%);The drug resistancce rates of ceftazidine,imipenem and piperacillin/tazobactam to PA was 20.3%,20.8% and 28.3% respectively;The drug resistance rates of Acinetobacter lwoffii was lower than Acinetobacter baumann/Haemolyticus.The incidence of ESBLs and IB of PA was 15.7% and 84.2% respectively.Conclusions The detective rate for the NF was high and the NF was mainly PA in lower respiratory tract.The resistance of the NF was very high and it was various to antibiotics.The incidence of IB of PA was high.