非发酵菌416株的临床分布和耐药性分析

Analysis on clinical distribution and drug-resistance of 661 strains of nonfermentative gram-negative bacilli

目的了解非发酵革兰阴性杆菌在医院感染中的耐药性特点，为临床正确选用抗菌药物提供科学依据。方法对我院2006～2007年临床各标本中分离的416株非发酵革兰阴性杆菌进行总结和耐药性分析，细菌鉴定和药敏试验采用Micro Scan40／96全自动微生物鉴定仪。结果416株非发酵革兰阴性杆菌（NFGNB）中，铜绿假单胞菌199株、不动杆菌属128株、嗜麦芽窄食单胞菌37株，分别占非发酵革兰阴性杆菌的47．84％、30．77％、8．89％，三者占非发酵革兰阴性杆菌的87．50％；药敏结果呈示，铜绿假单胞菌对亚胺培南、哌拉西林／三唑巴坦、头孢他啶、哌拉西林、替卡西林／棒酸、环丙沙星、左氧氟沙星、头孢吡肟的敏感率分别为96．7％、95．0％、94．9％、83．9％、82．0％、78．8％、76．4％、71．1％；对丁胺卡那、氨曲南、庆大霉素、妥布霉素的敏感率〈70％；头孢噻肟的敏感率〈10％；鲍曼不动杆菌对亚胺培南、氨苄西林／舒巴坦、丁胺卡那、替卡西林／棒酸、头孢他啶、左氧氟沙星的敏感率分别为98．7％、90．3％、86．5％、83．8％、74．3％、73．3％；嗜麦芽窄食单胞菌对左氧氟沙星、复方新诺明的敏感率为81．7％、73．8％；对头孢他啶、替卡西林／棒酸、环丙沙星的敏感率为40．4％、38．9％、27．5％；对丁胺卡那、庆大霉素、妥布霉素的敏感率〈15％；对亚胺培南天然耐药。结论非发酵革兰阴性杆菌是医院感染的主要病源菌之一，不同菌种的非发酵革兰阴性杆菌对药物的敏感性有较大差异，临床治疗应根据药敏试验及结合该菌的耐药机制选用、调整抗菌药物，避免滥用抗菌药，对于临床治疗和减少耐药菌株的发生都具有重要意义。

Objective To investigate the antimicrobial resistance of nonfermentative gram - negative bacilli （NFGNB） causing the nosoeomlal infection and provide reasonable reference for clinical application of anti - bacterial drugs. Methods Bacteria isolation and drug - sensitivity test were performed by using automatic Microsoan 40/96 analysor. Data from 416 strains of nonfermentative gram - negative bacilli isolated from specimens in this hospital from 2006 to 2007 were collected and their antimicrobial susceptiblity was studied. Results Among 416 strains of nonfermentative gram -negative bacilli, 199 of them were P. aeruginosa, 128 belonged to Acinetobacter and 37 as S. maltophilla. Their incidence rates in nonfermentative gram - negative bacilli were 47.84%, 30.77%, and 8.89% respectively. They were accounted for 87.50% of nonfermentative gram - negative bacilli. The results of drug - sensitivity showed that the sensitive rates of P. aeruginosa to imipenem, piperacillin/tazobactam, ceftazidime, piperacillin, ticarcillin/clavulanic, cipmfloxacin, levofloxacin and cefepime were 96.7 %, 95.0%, 94.9%, 83.9%, 82.0%, 78. 8%, 76.4% and 71.1% respectively. The sensitive rotes of P. aeruginosa to amikacin, aztreonam, gentamicin, and tobramycin were less than 70%. The sensitive rate of P. aeruginosa to cefotaxime was less than 10%. The sensitive rates of A. baumanii to imipenem, ampicillin/sulbac- tam, amikacin, ticarcillin/clavulanic, ceftazidime and levofloxacin were 98.7%, 90.3%, 86.5%. 83.8%, 74.3% and 73.3% respectively. The sensitive rates ofS. maltophilia to levofloxacin,trimethoprim/sulfamethoxazole, ceftazidime, aicarcillin/davulanic, and cipmfloxacin were 81. 7%, 77.93%, 40.4%, 38.9% and 27.5% respectively. The sensitive rates of S. maltophilia to amikacin, gentamicin, and tobramycin were less than 15%. S. maltophilia had a natural resistance to imipenem. Conclusion Nonfermentative gram - negative bacilli were important patho- gens causing nosecomial infection. Different kinds of nonfermentative gram - negative bacilli had a greater difference in drug sensitivity. Antibacte- rial drugs should be chosen and adjusted according to results of drug - sensitivity test. So that abuse of antibacterial drugs can be reduced. We can reduce the occurrence of drug - resistant bacteria only by this way. It is also very important for clinicians to prevent the occurrence of drug - resist- ant bacteria by avoidance of abuse of antimicrobials.