非发酵革兰阴性杆菌的临床调查与耐药性监测分析

Clinical investigation and drug resistance surveillance analysis on non-fermenting Gram-negative bacilli

目的了解我院2000-2004年非发酵革兰阴性杆菌的分布及耐药谱的变迁,以便于临床对非发酵细菌感染的监控与治疗。方法采用VITEK-32型微生物全自动分析仪进行菌种鉴定及药敏测试, 部分菌株药敏测试采用KB法。结果 5年间从临床标本中共分离出非发酵革兰阴性杆菌1 407株,占临床分离菌的34．13％。其中假单胞菌属的分离占绝对优势。对各类常见抗生素的药敏监测结果显示:醋酸钙-鲍曼复合不动杆菌、嗜麦芽窄食单胞菌和铜绿假单胞菌的耐药率及多重耐药率均呈明显上升趋势。所监测的各类抗生素以喹诺酮类抗生素环丙沙星对三种病原菌的敏感率下降最为明显。非发酵革兰阴性杆菌中嗜麦芽窄食单胞菌的耐药性最强,只有复方新诺明和阿米卡星的敏感率在50％以上。醋酸钙-鲍曼复合不动杆菌对碳氢霉希类抗生素亚胺培南敏感率最高,始终位居首位。铜绿假单胞菌则是对亚胺培南和头孢他啶的敏感率较高。结论非发酵革兰阴性杆菌已成为医院感染的重要病原菌之一。日常工作中应加强对非发酵革兰阴性杆菌感染的预防,对于感染的治疗要合理选用抗生素以提高治愈率。

Objective To study the distribution of the non-fermenting Gram-negative bacilli（NFB） and the change of its resistance between 2000 and 2004 in author＇s hospital, for better control and treatment of the infection of NFB.Methods VITEK-32 automated analysis system was used for NFB differentiation and drug resistance determination.Drug resistance determination of some bacilli isolates were detected by KB method.Results Totally 1 407 NFB isolates were obtained from clinical specimen between 2000 and 2004yr,The isolated rate was 34.13% in all of the clinical isolates.The isolated rate of Pseudomonas spp was the highest.The results of drug resistance surveillance showed that the drug resistance and multidrug resistance of Acinetobacter cal, coaceticus-baumannii complex,Pseudomonas aeruginosa and Stenotropho- monas maltophilia were raised markedly. In all of the antibiotic, the susceptible rate of ciprefloxacin to NFB descended significantly. The drug resistance of Stenotrophomonas maltophilia in all of isolated NFB was the highest.Except for amikacin and trimethoprim/sulfa,the susceptible rate of antibiotics to stenotrophomonas maltophilia was less than 50%. The susceptible rate of imipenem to Acinetobacter calcoaceticus-baumannii complex was highest all long. The suseeptible rate of imipenem and ceftazidine to Pseudomonas aeruginosa was higher.Conclusion NFB has been one of the best important pathogenic bacteria in hospital acquired infection. At ordinary times the precaution in an infection of NFB should be strengthened. To treat the NFB infection, antibiotic should be used rationally.