重症监护病房非发酵菌感染分布特点及耐药情况分析

Distribution and antimicrobial resistance of non-fermenters isolated from intensive care unit

目的：分析我院重症监护病房（ICU）非发酵菌感染分布及其耐药情况。方法：选取2009年1月～2011年12月我院重症监护病房（ICU）患者,回顾性分析各类临床标本分离的非发酵菌株作体外药敏试验结果。药敏试验采用MIC法及K-B法,按CLSI2010年版判断标准。结果：共分离非发酵菌447株.其中前四位的分别是鲍曼不动杆菌207株（46.31%）、铜绿假单胞菌144株（32.21%）、嗜麦芽窄食单胞菌49株（10.96%）、伯克霍尔德氏菌36株（8.05%）。鲍曼不动杆菌仅对头孢哌酮/舒巴坦耐药率较低,为1.55%,对亚胺培南、美洛培南耐药率分别为49.61%、53.48%。铜绿假单胞菌对亚胺培南、美洛培南、阿米卡星及头孢哌酮/舒巴坦耐药率较低,分别为25.95%、29.01%、35.11%及0.76%,嗜麦芽窄食单胞菌及伯克霍尔德氏菌对多种抗菌药物天然耐药,对复方新诺明,喹诺酮类药物耐药率较低。推荐临床治疗使用。结论：非发酵菌是重症监护病房感染常见病原菌,对常用抗菌药物耐药情况严重。应加强耐药性监测,为临床合理应用抗生素,防止院内感染提供依据。

Objective： To analyze the characteristics of infection distribution and antimicrobial re- sistance of non-fermenters isolated from intensive care unit （ICU） at the second hospital of Anhui Medical University. Methods. Non-fermenters were separated and identified from the ICU patients that were ad- mitted to the Second Hospital of Anhui Medical University from January 2009 to December 2011. The antimicrobial susceptibility testing （AST） of non-fermenters was determined by K-B disk diffusion method and minimal inhibitory concentration （MIC） test, respectively. The AST was performed as recommended by CLSI 2010. Results. A total of 447 strains of non-fermenters were isolated from clinical specimens. The four top identified microorganisms were Acinetobacter baumannii （207, 46.31%）, Pseudomonas aeruginosa （144, 32. 21%）, Stenotrophomonas maltophilia （49, 10. 96%） and Burkholderia （36, 8. 05%）. The resistance rate of Acinetobacter baumannii to cefoperazone/sulbactam was 1.55% while its resistance to Imipenem and Meropenem significantly increased to 49.61% and 53.48 %, respectively. Resistance of Pseudomonas aeruginosa to Imipenem, Meropenem, Amikacin, and Cefoperazone/sulbactam were 25.95%,29.01%, 35.11% and 0.76%, respectively. In contrast to the low resistance rates to sulfamethoxazole and quinolones, Stenotrophomonas maltophilia and Burkholderia had natural resistance to multiple antimicrobial drugs. Conclusions：As prevalent pathogenic agents in ICU, non-fermenters have considerable resistance to commonly used antibiotics. Thus, periodic surveillance is essential for the rational use of antibiotics and the effective prevention of nosocomial infections.