非发酵革兰阴性杆菌867株耐药性分析

Analysis of bacterial resistance of 867 strains of nonfermenters gram-negative bacilli

目的了解3年内我院感染常见非发酵革兰阴性杆菌的耐药情况，为临床医师更合理应用抗菌药物提供参考。方法收集2006年1月至2008年12月我院就诊患者的标本中分离获得的867株非发酵革兰阴性杆菌，采用美国DadeMicroScan公司生产的AutoSCAN4半自动鉴定仪及配套的生化反应药敏板进行鉴定，药敏试验方法采用微量稀释法。结果867株非发酵菌中铜绿假单胞菌占64．7％，鲍曼不动杆菌占16．0％，2种主要非发酵革兰阴性杆菌共占80．7％，它们对美罗培南、亚胺培南耐药率较低，耐药率分别是9．0％、12．4％，其次是哌拉西林／他唑巴坦、阿米卡星、替卡西彬克拉维酸、左氧氟沙星、环丙沙星、氨苄西林／舒巴坦，耐药率分别是30．2％、32．0％、32．3％、34．6％、37．4％、38．1％，其余抗菌药物耐药率都〉40％。结论铜绿假单胞菌、鲍曼不动杆菌是引起医院感染的主要非发酵革兰阴性杆菌，治疗上应根据药敏结果选用抗菌药物，并结合其耐药特点应用具有协同作用的不同类型抗菌药物。

Objective To analyze the drug resistance of mian nonfermenters Gram-negative bacilli during the past 3 years for the reference to clinical antibiotics administration. Methods Routine method was used to iso- late and identify, Pathogens were identifed by AutoSCAN4 （ Dade Microscan, USA ） and identified tests. The Mic susceptibility test was used as drug resistance test. Results Among 867 strains of nonfermenters Gram-negative ba- cilli, Pseudomonas aeruginoa was 62.5% and Acinetobacter was 17.8% （ totally 80.3% ）. Meropenem and imipen- em showed low resistance rates （9.0% and 12.4% respectively）. Resistance rates of piperacillin/tazobactam, ami- kacin, ticarcillin/kclavulanate, levofloxacin, ciprofloxacin, ampicillin/sulbactam were 30.2% , 32.0% ,32.3 % , 34. 6% ,37.4% and 38. 1%, respectively. Resistance rates of other antibiotics were all over 40%. Conclusions Paeruginosea and Acinetobacter are important nonfermenters Gram-negative baclli causing nosocomial infection. It is suggested that antibiotics be used under the guidance of antibiotics susceotibility testing. Drug combination therapy should be considered according to the resistant mechanism of bacteria. Nonfermenters Gram-negative bacilli; Nosocomial infection; Drug resistance