心脏外科重症监护病房非发酵革兰阴性杆菌感染分析

Nosocomial Gram-negative Non-fermenting Bacteria Infection in Patients after Cardiac Surgery

目的调查心脏外科重症监护病房（ICU）非发酵革兰阴性杆菌医院感染状况及耐药性，以指导临床合理使用抗菌药物。方法回顾2005年1月-2008年12月医院心脏外科ICU所分离的非发酵革兰阴性杆菌，纸片扩散（K—B）法进行药敏试验。结果4年中共分离到非发酵革兰阴性杆菌167株，其中呼吸道感染148例，血液感染13例，其他部位感染6例，最多见的依次是不动杆菌属59株（35．3％）、铜绿假单胞菌50株（29．9％）和嗜麦芽寡养单胞菌42株（25．1％）；不动杆菌属对头孢哌酮／舒巴坦、美罗培南和亚胺培南的敏感率最高，分别为74．1％、71．4％和67．8％，头孢哌酮／舒巴坦、亚胺培南、哌拉西林／他唑巴怛、环丙沙星和美罗培南对铜绿假单胞菌保持良好的抗菌活性，分别为97．1％、90．0％、87．1％、83．1％、80．0％，复方新诺明和环丙沙星对嗜麦芽寡养单胞菌的敏感率为100．0％，左氧氟沙星及头孢哌酮／舒巴坦分别为74．1％和70．0％。结论非发酵革兰阴性杆菌是医院感染的重要病原菌，耐药性呈增加趋势，应合理使用抗菌药物，并注意医源性交叉感染。

OBJECTIVE To investigate the clinical distribution and antibiotics resistance of nosocomial Gramnegative non-fermenting bacteria infection in patients after cardiac surgery. METHODS The clinical data of 296 patients with microbiologically documented nosocomial infection from Jan 2005 to Dec 2008 were analyzed retrospectively. RESULTS There were 167 strains of Gram-negative non-fermenting bacilli, and 147 （88.6%） of them were isolated from sputum while 13 （7.8%） from blood. Acinetobacter spp（59 strains, 35. 3%）, Pseudomonas aeruginosa （50 strains, 29.9 % ）, Stenotrophomonas maltophilia （42 strains, 25. 1% ） were the predominant Gramnegative bacilli. Bacterial resistance rate of Acinetobacter to cefoperazone/sulbactam, meropenem and imipenem were 74.1 %. 4% and 67.8%. The P. aeruginosa isolates showed high sensitivity to cefoperazone/ sulbactam （97.1% ）, imipenem （ 90 % ）, piperacillin/tazobactam （87.1% ）, ciprofloxacin （83.1% ） and meropenem （80%）. The antibiotics presented high activity against S. maltophilia included trimethoprim/sulfamethoxazole （100%）, ciprofloxacin （100%） , followed by levofloxacin （ 74. 1%） and cefoperazone/sulbactam （70%）. CONCLUSIONS Gram-negative non-fermenting bacteria are the important pathogens in ICU in our department and present multidrug resistance. Rational use of antibiotics is very important to reduce drug resistant strains.