重症监护病房非发酵革兰阴性杆菌耐药性变迁

Changes of Pathogens and Antimicrobial Resistance of Nonfermenting Gram-negative Bacilli in Intensive Care Unit

目的研究重症监护病房(ICU)非发酵革兰阴性杆菌感染状况及耐药性,以指导临床合理使用抗菌药物。方法收集2003年1月-2007年12月ICU所分离的非发酵革兰阴性杆菌,采用纸片扩散法进行体外药敏测定。结果5年中共分离到非发酵革兰阴性杆菌386株,最多见的依次是不动杆菌属219株、铜绿假单胞菌117株和嗜麦芽寡养单胞菌36株;非发酵革兰阴性杆菌对大多数抗菌药物呈高耐药性,不动杆菌属对亚胺培南、头孢哌酮/舒巴坦和哌拉西林/他唑巴坦的耐药率最低,分别为3.7%、28.3%和42.9%;2007年对亚胺培南的耐药率升高至21.7%;近2年铜绿假单胞菌对亚胺培南的耐药率明显升高(58.0%),对头孢哌酮/舒巴坦的总耐药率最低(20.5%);嗜麦芽寡养单胞菌较敏感的是头孢他啶、头孢哌酮/舒巴坦和哌拉西林/他唑巴坦。结论非发酵菌是ICU重要的病原菌,加强其流行及耐药性监测可以为临床合理使用抗菌药物提供依据。

OBJECTIVE To study the isolation status and antimicrobial resistance of nonfermenting Gram-negative bacilli collected from intensive care unit（ICU） of our hospital so as to instruct the rational clinical application of antibiotics. METHODS The antimicrobial resistance of nonfermenting Gram-negative bacilli isolates collected from patients in ICU from Jan 2003 to Dec 2007 was analyzed. Antimicrobial susceptibility of clinical isolates were tested by Kirby-Bauer method. RESULTS Total 384 nonfermenting Gram-negative bacilli isolates were collected in 5 years. The most common species were Acinetobacter baumannii （219）, Pseudomonas aeruginosa （117） and Stenotrophoznonasrnaltophilla （36）. The antimicrobial resistance rate of nonfermenting Gram-negative bacterial to most antibiotics were much higher. The antimicrobial resistance rate of Acinetobacter spp to imipenem, cefoperazone/sulbactam and piperacillin/tazobactam was 3.7%, 28. 3% and 42. 9%. But the resistance rate of Acinetobacter spp to imipenem was increased in recent 2 years（58.0%）. The antimicrobial resistance rate of P. aeruginosa to cefoperazone/sulbactam was the lowest. That of imipenem-resistant P. aeruginosa to cefoperazone/ sulbactam was 34. 0%. S. maltophilla was relatively susceptible to ceftazidime, eefoperazone/sulbaetam and piperacillin/tazobactam. CONCLUSIONS Nonfermenters Gram-negative bacilli are the important pathogens in ICU. Surveillance of their prevalence and drug resistance may provide evidences for rational antibiotic choices.