非发酵菌临床分布及耐药性的动态分析

Clinical Distribution of Nonfermenter and Its Resistance

目的了解1999～2003年我院非发酵菌的分布及耐药谱的变迁,为临床合理选用抗生素提供依据. 方法细菌鉴定、药敏实验和诱导β-内酰胺酶(IB)检测采用WalkAway-40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5年间非发酵菌的检出率分别为14.4%、16.6%、15.3%、18.0%、18.8%,其中以铜绿假单胞菌为最多(54.5%),其次为鲁氏不动杆菌(10.6%)、鲍氏/溶血不动杆菌(10.4%)和嗜麦芽寡养单胞菌(6.0%).非发酵菌在痰液中分离率最高(44.8%).亚胺培南和头孢他啶对铜绿假单胞菌敏感率最高,从2001年的80%和79%下降到2003年的66%,头孢噻肟和头孢曲松对铜绿假单胞菌的敏感率最低(<15%);复方新诺明对嗜麦芽寡养单胞菌的敏感率最高,从1999年的75%上升到2003年的91%,其他抗生素敏感率较低;鲁氏不动杆菌比鲍氏/溶血不动杆菌敏感率普遍偏高.铜绿假单胞菌ESBLs和IB的检出率分别为15.2%和83.3%. 结论五年间铜绿假单胞菌、鲍氏/溶血不动杆菌和嗜麦芽寡养单胞菌的分离率有逐渐增加的趋势;非发酵菌除鲁氏不动杆菌外耐药性普遍较高;铜绿假单胞菌IB发生率高.

OBJECTIVE To study the distribution of the nonfermenter(NF) and the change of its resistance between 1999 and 2003 in our hospital, and instruct clinical application of antibiotics reasonably. METHODS The identification of bacteria, antibiotic susceptibility and the detection of inducible beta lactamase (IB) were done by MicroScan WalkAway 40. Extended spectrum beta lactamases (ESBLs) were confirmed by ESBLs phenotype affirmative test in accord to NCCLS. RESULTS The detective rate of the NF was 14 4%,16 6%,15 3%,18 0% and 18 8%, respectively, between 1999 and 2003. Pseudomonas aeruginosa(PA), Acinetobacter lwoffii, A. baumannii/ A. haemolyticus and Stenotrophomonas maltophilia accounted for 54 5%,10 6%,10 4% and 6 0%, respectively. The highest distribution of the NF was in the sputum. The susceptible rate of imipenem and ceftazidine to PA was higher, however, it had dropped from 80% and 79% in 2001 to 66% in 2003. The susceptible rate of cefotaxime and ceftriaxone to PA was lower(<15%). The susceptible rate of sulfamethoxazole/trimethoprim to C. maltophilia was higher than the others, and rose from 75% in 1999 to 91%in 2003. The susceptible rate of A.lwoffii was higher than A.baumannii/A.haemolyticus. The incidence rates of ESBLs and IB of PA were 15 2% and 83 3%,respectively. CONCLUSIONS The detective rates of PA, A.baumannii /A.haemolyticus and C.maltophilia are gradually increased during the last five years. The resistance of the NFs, but A. lwoffii, to antibiotics is higher. The incidence of IB of PA is also higher.