褪色沙雷菌的医院感染分布与耐药性分析

Distribution and drug resistance of Serratia marcescens causing nosocomial infections

目的了解褪色沙雷菌在医院感染的临床分布和在ICU与非ICU的耐药性,为临床合理选择和应用抗菌药物提供依据。方法用K-B法对临床分离出的156株褪色沙雷菌进行体外药物敏感试验并统计分析,同时检测其β-内酰胺酶。结果分离培养的156株褪色沙雷菌在科室分布,ICU 57株占36.5%、呼吸科52株占33.3%、神经内科28株占17.9%、其他科室19株占12.2%;对亚胺培南、头孢哌酮/舒巴坦的医院平均耐药率分别为3.8%和1.9%,对氨苄西林、头孢唑林、阿莫西林/克拉维酸的耐药率均>90.0%;检测产AmpC酶菌21株,检出率为13.5%,产ESBLs菌18株,检测率为11.5%,同时产AmpC酶和ESBLs菌7株,检出率为4.5%。结论ICU分离培养的褪色沙雷菌的耐药率显著高于非ICU分离培养的菌株;AmpC酶和ESBLs的3个表型的检出率ICU明显高于非ICU;褪色沙雷菌耐药机制复杂,对抗菌药物具有多药耐药性,临床应根据药敏试验结果合理选择抗菌药物。

OBJECTIVE To explore the clinical distribution and drug resistance of Serratia marcescens causing nosocomial infections in the ICU and non-ICU so as to provide bases for reasonable use of antibiotics. METHODS The in vitro drug susceptibility testing was performed for 156 clinical isolates of S. marcescens by using KB method, β-lactamase was detected at the same time. RESULTS Of 156 strains of S. marcescens cultured and isolated, there were 57 （36.5%） strains in ICU, 52 （33. 3%） strains in respiratory department, 28 （17. 9%） strains in neurology department, and 19 （12.2 %） strains in other departments; the average drug resistance rates to imipenem and cefoperazone/sulbactam were 5.1 % and 1.9 %, the drug resistance rates to ampicillin, cefazolin, and amoxicillin/clavulanic acid were higher than 90. 0%; there were 21 strains of Ampc enzyme-producing S. marcescens detected with the detection rate of 13. 5%, 18 strains of ESBLs-producing S. marcescens with detection rate of 11.5% and 7 strains of both Ampc enzyme and ESBLs-producing S. marcescens with detection rate Of 4.5 %. CONCLUSION The drug resistance rate of S. marcescens strains isolated from ICU is significantly higher than those isolated from non-ICUs; the detection rates of the three phenotypes of Ampc and ESBLs are higher in ICU than in non-ICUs; the drug resistant mechanism of S. marcescens is complex, and S. rnarcescens is resistant to multiple antibiotics, it is necessary to reasonably choose antibiotics on the basis of drug susceptibility testing.