下呼吸道感染中4种非发酵菌的临床分布及耐药性分析

Clinical distribution and drug resistance of 4 non-fermenting bacteria of lower respiratory tract infection

目的了解下呼吸道感染中4种非发酵菌的临床分布及耐药现状。方法采用回顾性调查方法,对2007年6月至2009年12月浙江大学医学院附属第一医院呼吸内科和ICU下呼吸道感染患者,调查其4种非发酵菌分离菌株,统计药敏试验结果及临床分布。结果共分离目标菌393株,包括鲍曼不动杆菌152株,铜绿假单胞菌127株,嗜麦芽窄食单胞菌73株,洋葱伯克霍尔德菌41株;分离菌株数最多的原发病依次是慢性阻塞性肺部疾患（24.4%）,原发性支气管肺癌（16.5%）,支气管扩张（14.8%）和肺炎（12.2%）;药敏试验结果,4种非发酵菌普遍呈多药耐药趋势,其中氨苄西林/舒巴坦、庆大霉素、哌拉西林耐药率均〉50%,亚胺培南和美罗培南的耐药率〉37.8%;耐药率最低的是头孢哌酮/舒巴坦和哌拉西林/他唑巴坦,分别为14.2%~26.8%和25.2%~50.7%。结论下呼吸道标本中分离到非发酵菌的患者,主要集中在9类住院治疗的患者,分离的菌株数量以COPD、原发性支气管肺癌等原发病患者较多,这些患者是医院感染的易感人群,应予以严密监视。体外药敏试验表明,4种非发酵菌的耐药性非常严重,需要定期公布细菌检测和耐药率变迁信息,制订和完善预防措施,加强临床和实验室的协作和沟通,以降低医院感染发生率和细菌耐药率。

Objective To understand the lower respiratory tract infections by 4 non-fermenting bacteria and their drug resistance and clinical distribution.Method A retrospective survey method was used to analyze the antimicrobial susceptibility and clinical distribution of 4 non-fermenting bacteria isolated from patients with lower respiratory tract infection in the Respiratory Medicine department and ICUs of our hospital during June 2007 to December 2009.Result A total of 393 target strains were isolated,including Acinetobacter baumannii（152 strains）,Pseudomonas aeruginosa（127 strains）,Stenotrophomonas maltophilia（73 strains）,and Burkholderia cepacia bacteria（41 strains）;The primary disease from which the highest number of isolates were obtained was chronic obstructive pulmonary disease（24.4%）,followed by primary lung cancer（16.5%）,bronchiectasis（14.8%） and pneumonia（12.2%）.Susceptibility test revealed that the 4 kinds of non-fermentative bacteria tend to be multi-drug resistant,with the resistance rates to ampicillin/sulbactam,gentamicin and piperacillin 50%,and to Imipenem and meropenem 37.8%;The lowest resistance rates were against cefoperazone/sulbactam and piperacillin/tazobactam,with the ranges of 14.2% to 26.8% and 25.2% to 50.7%,respectively.Conclusion Lower respiratory tract specimens were non-fermentative bacteria isolated mainly from hospitalized patients with 9 kinds of diseases,such as COPD and primary lung cancer.These patients are susceptible to nosocomial infection and should be closely monitored.In vitro susceptibility testing shows that the drug resistance of the four kinds of non-fermenting bacteria is very serious,and information on changes in drug resistance should be announced regularly to develop and improve preventive measures,so as to reduce nosocomial infection rate and the bacterial resistance rate.