沙雷菌属细菌医院感染的分布特点及耐药性分析

Antibiotic resistance and clinical characteristies of serratia in nosocomial infection cases

目的了解沙雷菌属细菌医院感染的分布特点及对常用抗菌药物的耐药特性,为临床抗感染治疗提供依据。方法对本院2004年1月-2006年12月间临床分离的242株沙雷菌的来源部位及耐药性进行统计分析,用表型筛选及三维试验法检测ESBLs和AmpC酶。结果242株沙雷菌主要来自呼吸道占78.5%、手术部位占10.3%、泌尿道占7.9%;病房分布主要见于重症监护病房38.4%、呼吸科病房32.6%、神经内科病房14.5%;菌种构成为粘质沙雷菌占80.2%、液化沙雷菌占11.6%;沙雷菌属细菌对舒普深和亚胺培南的耐药率较低,分别为5.5%和7.8%,对氨苄西林、头孢唑林、哌拉西林的耐药率均大于80%;产ESBLs和产AmpC酶细菌分别占11.6%和14.5%,同时产AmpC酶及ESBLs菌占5.4%。结论沙雷菌属细菌是引起医院感染的常见病原菌,其分离数逐年增多,以粘质沙雷菌最多见,沙雷菌耐药严重,耐药性的产生与细菌产生AmpC酶和ESBLs有关,临床应根据药敏试验结果合理选用抗菌药物。

Objective To investigate the antibiotic resistance and clinical characteristies of serratia in nosocomial infection cases so as to provide references for clinical therapy. Methods Distribution and antibiotic resistance of serratia isolated in nosocomal infection cases from January 2004 to December 2006 were analyzed.The drag sensitivity tests of serratia strains was done by Kirby-Bauer method.The AmpC enzymes and ESBLs were detected by phenotype screening and three dimensional tests.Results The main localities from where the serratia were isolated were respiratory tract （78.5 % ）, operation sites （10.3 % ） and urinary tract （7.9%）. Wards from where serratia were isolated were mainly ICU, respiratory and neurological division. A total of 242 serratia consisted mainly of S. mamescens （80.2%）, S. liquefaciens （ 11.6% ）. Among 242 strains of serratia, the resistant rates to ampicillin, cefazolin, piperacillin were above 80%, while to sulperazone,imipenem were lower,5.5% and 7.8% ,respectively. Out of 242 serratia strains,5.4% produced both AmpC enzymes and ESBLs. Conclusion Serratia is the cormroon pathogen in nosocomial infections,and S.marcescens is more often isolated than others. The producing AmpC enzymes and/or ESBLs serratia strains resisted to many antibiotics,and the numbors of isolated serratia strains have increased in recent years. Therefore, antibiotics should be reasonably used according to the drug sensitivity.