非发酵菌的分布及耐药分析

Distribution of nonfermenter and its resistance

目的:了解我院非发酵菌的分布及耐药趋势的特点,分析感染的危险因素,为临床合理使用抗菌药物提供依据。方法:细菌鉴定采用法国生物梅里埃公司API鉴定系统;药敏试验采用K-B法。结果:分离出355株非发酵革兰阴性杆菌,检出率为26.2%。其中以铜绿假单胞菌最多(62.7%),其次是鲍曼不动杆菌(12.8%)、嗜麦芽窄食单胞菌(11.5%)和洋葱伯克霍尔德(5.4%)。非发酵菌的感染部位以呼吸道最多(79.5%),其次为创面分泌物(10.8%)和引流液(5.2%)。84.2%的感染患者伴有各种基础性疾病。病区分布主要为肿瘤科病房(51.9%)、内科病房(25.6%)。铜绿假单胞菌对哌拉西林/他唑巴坦、亚胺培南、阿米卡星、头孢他啶、环丙沙星耐药率低;不动杆菌属对亚胺培南、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦耐药率低;嗜麦芽寡养单胞菌对米诺环素、复方新诺明、左氧氟沙星、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦耐药率低;洋葱假单胞菌对头孢他啶、复方新诺明、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦耐药率低。结论:非发酵菌的临床分离率和耐药率高,临床分布范围广。应加强对产酶菌和多重耐药菌的预防监测;治疗非发酵菌感染宜选用敏感抗菌药物治疗,同时应积极治疗原发病,避免各种高危因素。哌拉西林-舒巴坦与头孢哌酮/舒巴坦等加酶抑制剂对多种非发酵菌具有良好的体外抗菌活性,可作为临床非发酵菌感染经验治疗的首选方案。

Objective：To study the distribution of the nonfermenter （NF） and the change of its resistance in our hospital, and analyze the risk factors, in order to provide a basis for clinical reasonably antibiotics application. Method：The identification of bacteria was done by API, antibiotic susceptibility was tested by K-B method. Re- suit：355 strains of nonfermenter were separated and the detective rate of NF was 26.2 %. Pseudomonas aerugino- sa, A. baumanii, Stenotrophomonas maltopbilia and Burkholderia cepacia accounted for 62.7%, 12.8 %, 11. 5% and 5.4% ,respectively. The highest distribution of the NF was in the sputum, the second were wound exudate （10.8%） and drainage（5.2%）. The infected patients with a variety of basic diseases were 84.2%. The main dis- tribution of ward：Oncology ward was 51.9 % and Internal medicine ward was 25.6 %. The resistant rate of Pseud- omonas aeruginosa to Imipenem, Piperacillin/tazobactam and Cefoperazone/sulbactam was low. The resistant rate of Acinetobacter to Piperacillin/tazobactam, Imipenem, Amikacin, Ceftazidime and Ciprofloxacin was low. The resistant rate of Stenotrophomonas maltophilia to Minocyeline, Paediatric Compound Sulfamethoxazole, Levoflox- acin, Piperacillin/tazobactam and Cefoperazone/sulbactam was low. The resistant rate of Burkholderia cepacia to Ceftazidime, Paediatric Compound Sulfamethoxazole, Piperaeillin/tazobactam and Cefoperazone/sulbactam was low. Conclusion：Nonfermenter clinically isolated rate and drug resistance rate were high, and its distribution was wide. The hospital should enhance the detection of enzyme producing bacteria and multi-drug resistant bacteria. The treatment of Nonfermente infection should choose the sensitive antibiotics, cure the original diseases actively, and avoid all kinds of risk factors. β-lactam/β-lactamase inhibitor compound preparation such as Piperacillin/Sul- bactam and Cefoperazone/sulbactam could be used as the preferred option because of their good antibacterial activi- ty in vitro to nonfermenter.