1999-2003年湖北地区嗜麦芽窄食单胞菌感染状况及耐药变迁

Changes of Antimicrobial Resistance among Stenotrophomonas maltophilia Isolated from 1999 to 2003 in Hubei Area

目的了解湖北地区嗜麦芽窄食单胞菌的来源、临床分布及耐药变迁，为临床合理用药提供依据。方法收集1999～2003年湖北地区15所三级甲等医院初次分离的1185株嗜麦芽窄食单胞菌，采用纸片扩散法测定其对18种常用抗菌药物的耐药特征，用“WHONET-5”软件完成统计分析。结果1999-2003年湖北地区15所医院临床标本中嗜麦芽窄食单胞菌的分离率从2．3％（243株／10584株）下降到1．7％（243株／14294株）。以呼吸道标本最多（74．6％），其次为伤口分泌物（7．0％）、血液和骨髓（6．0％）、引流液和穿刺液（5．3％）。临床分布以内科（40．8％），外科（22．2％），重症监护病房（17．1％）为主。5年中抗菌药物对嗜麦芽窄食单胞菌的累计敏感率依次为左旋氧氟沙星（80．4％）、替卡西林／克拉维酸（70．8％）、TMP／SMZ（60．2％）、头孢哌酮／舒巴坦（56．8％）、环丙沙星（50．9％）、头孢他啶（48．5％）；TMP／SMZ的敏感率由65．6％下降到53．1％，头孢哌酮／舒巴坦的敏感率由71．8％下降到48．4％，环丙沙星的敏感率由59．4％下降到50．2％，头孢他啶的敏感率由56．4％下降到42．5％。结论嗜麦芽窄食单胞菌以呼吸系统感染为主，对左旋氧氟沙星、替卡西林／克拉维酸、TMP／SMZ的累计敏感率在60％以上，经验用药时可作为首选。

Objective To investigate the antimicrobial resistance among Stenotrophomonas maltophilia from 1999 to 2003 in Hubei Area. Methods Disc diffusion method was used to detect the zone diameters of 1 185 initial isolates against 18 antibiotics in the past 5 years, and the data was analyzed by the software ＂WHONET-5＂. Results Most of the 1 185 strains were isolated from respiratory tract （74.6% ）. Most of the strains were isolated from the department of internal medicine （40.8 % ）, department of surgery （22.2 %） and ICU （17.1%）. The accumulation susceptibility of the 18 antibiotics were Levofloxacin （80.4 %）, Ticarcillin/Clavulanic acid （70.8%）, TMP/SMZ （60.2 %）, Cefoperazone/Sulbactam （56.8 %）, Ciprofloxacin （50.9 %）, Ceftazidime （48.5 %）. The susceptible rates of TMP/SMZ, Cefoperazone/Sulbactam, Ciprofloxacin and Ceftazidime were decreased from 65.6 % to 53.1%, from 71.8 % to 48.4 %, from 59.4 % to 50.2 % and from 56.4% to 42.5%respectively. Conchlsion In recent 5 years, most of Stenotrophornonas maltophilia infections were in respiratory system, and the susceptibility rate of Levofloxacin, Ticarcillin/Clavulanic acid, TMP/SMZ was above 60 %. These 3 antibiotics were the most ideal antibiotics for Stenotrophomonas maltophilia infection.