不常见非发酵菌对常见抗菌药物敏感性分析

Antimicrobial susceptibility of uncommon nonfermenting Gram-negative bacilli

目的了解临床分离的伯克霍尔德菌属、金色杆菌属、产碱杆菌属等不常见非发酵菌的耐药性。方法从2004年～2006年临床各种标本中分离到的不常见革兰阴性杆菌用VITEK-2全自动微生物分析仪进行检测鉴定，药物敏感性试验采用纸片扩散法。数据分析采用WHONET5．4软件进行处理、统计和分析。结果两年中中山大学第-附属医院共收集患者首次分离株118株，其中伯克霍尔德菌属47株（其中洋葱伯克霍尔德菌41株，皮氏伯克霍尔德菌6株），金色杆菌属44株（其中脑膜脓毒性金黄杆菌17株，产吲哚金黄杆菌23株），产碱杆菌属27株（其中粪产碱杆菌13株，木糖氧化无色杆菌12株）。96．6％的菌株来源于痰标本。对伯克霍尔德菌属有较强体外抗菌活性的依次为：复方磺胺甲曙唑（87．2o,4）、哌拉西林／_-唑巴坦（87．0％）、左氧氟沙星（85．3oA）、头孢吡肟（83．0％）、头孢他啶（78．6％）和头孢哌酮／舒巴坦（78．3％）。对金色杆菌属有较强体外抗菌活性以复方磺胺甲哩唑（87．5％）最高。对产碱杆菌属敏感性较高的药物分别为头孢哌酮／舒巴坦（84．6％）和美罗培南（77．8%）。结论头孢哌酮／舒巴坦对三种非发酵菌都有较高体外抗菌活性。常规实验室鉴定方法易将三种菌相互混淆，甚至与氧化酶阴性的非发酵菌混淆，这可能是造成各地报道药敏结果差异的原因之一。

Objective To investigate the antimicrobial susceptibility of uncommon nonfermenting Gram-negative bacilli such as Burkholderi spp. , Chryseobacterium spp. and Alcaligenes spp. from a hospital in Guangzhou from 2004 to 2006. Methods Disc diffusion test （KB methods） was employed to study the antimicrobial susceptibility. WHONET 5.4 was applied for date analysis. Results In two years of study from 2004 to 2006, 118 strains were isolated firstly from each patient, including 44 strains of Burkholderia spp. （41 strains of Burkholderia cepacia）, 41 strains of Chryseobacterium spp. （17 C. meningosepticum and 23 C. indologenes）, 27 strains of Alcaligenes spp. （13 A. faecailis and 12 A. xylosoxidans）, 96.6% of strains were isolated from sputum. The susceptibility rates of Burkholderia spp. to trimethoprim/sulfamethoxazole （SMZ/TMP）, piperacillin/tazobactam, levofloxacin, cefepime, ceftazidime and cefoperazone/sulbactam were 87.2%, 87.0%, 85.30 , 83.0%, 78.6% and 78.3%, respectively. SMZ/TMP was the most active agent against Chryseobacterium spp. with the susceptible rates of 87.5%. Cefoperazone/sulbactam and meropenem had the most activity against Alcaligenes spp. with susceptible rates 84.6% and 77.8%, respectively. Conclusion Cefoperazone/sulbactam was the better agent against the three species and these species were not distinguishal by routine laboratory test, oven so with oxydase-negative non-fermenting Gram-negatine bactilli which may be one of reasons causing the different susceptible rates among various laboratories.