1137株非发酵革兰阴性菌耐药情况分析

Drug-Resistance Analysis of 1 137 Strains of Non-Fermenting Gram-Negative Bacteria

目的对非发酵菌的临床特征及耐药情况进行分析，为临床医生合理应用抗生素提供依据。方法应用VITEK2Compact全自动微生物分析仪鉴定临床菌株，wHONET5．6分析软件对2011年1月～2012年3月分离的1137株非发酵革兰阴性菌进行回顾性分析，并对2011年第一季度和2012年第一季度非发酵革兰阴性杆菌耐药情况进行比较。结果2011年1月～2012年3月共检出非发酵菌1137株，占临床分离率的28％（1137／4040）。其中，铜绿假单胞菌占54．5％（620株），鲍曼不动杆菌占37．6％（428株），嗜麦芽窄食单胞菌占4．0％（45株）。非发酵菌临床标本主要来源于痰液，其次为尿液和血液标本。鲍曼不动杆菌对8-内酰胺类、氨基糖苷类、氟喹诺酮类和磺胺类的耐药率均〉50％，鲍曼不动杆菌对抗生素的耐药率分别为亚胺培南59．8％，庆大霉素68．8％，妥布霉素69．8％，左旋氧氟沙星69．5％，头孢吡肟75．3％和头孢他啶69．5％。铜绿假单胞菌对抗生素的耐药率分别为亚胺培南39．1％，庆大霉素18．9％，妥布霉素7．3％，左旋氧氟沙星21．4％，头孢吡肟39．8％和头孢他啶36．6％。2012年第一季度比2011年同季度的耐药情况严重，其中，非发酵革兰阴性杆菌对亚胺培南的耐药情况加重最为明显。结论非发酵菌感染及耐药情况比较严重，所以控制院内感染并指导临床经验用药，监测非发酵菌临床分布特征和耐药情况刻不容缓。

Objective To explore the clinical characteristics and the drug resistance of non-fermenting gram- negative bacteria, and to provide the scientific evidence for clinically reasonable use of antibiotics. Methods VITEK-2 Compact was used to identify the clinical strains. WHONET 5.6 software was used to ana- lyze 1 137 strains of non-fermenting gram-negative bacteria （Jan 2011 Mar 2012） and to compare the resistance of non-fermenting gram-negative bacteria between the first quarter of 2011 and first quarter of 2012. Results Non-fermenting gram-negative bacteria account for 28%（1 137/4 060）of isolates examined in clinical microbiology laboratories. The top three of the isolation rate among 1137 strains of non-fer- menting gram-negative bacteria were Pseudornonas aeruginosa, Acinetobacter baumannii and Stenotro- phomonas maltophilia,accounting for 54.5 % （620 strains） ,37.6% （428 strains）and 4.0 % （45 strains）, respectively. Most of the non-fermenting gram-negative bacteria were isolated from sputum, urine and blood specimens. More than 50% of A. baumannii isolates tested were resistant to beta-lactams, amin- oglycosides,fluoroquinolones and sulfonamides. Resistance rates among A. baumannii were： imipenem 59.8%, gentamicin 68.8%, tobramycin 69.8%, levofloxacin 69.5%, cefepime 75.3% and ceftazidime 69.5% respectively. Resistance rates among P. Aeruginosa were：imipenem 39.1 %, gentamicin 18.9%, tobramycin 7.3% ,levofloxacin 21.4% ,cefepime 39.8% and ceftazidime 36.6% respectively. The drug resistance of the first quarter in 2012 was more serious than the first quarter in 2011 ,and the antibiotic resistance rate in non-fermenting gram-negative bacteria to imipenem increased obviously. Conclusion Non-fermenting gram-negative bacteria had gained increasing antimicrobial resistance. To control the nosocomial infection and to guideempirical antimicrobial prescribing. It is immediate to survey the clinical characteristics and the drug resistance of non-fermenting gram-negative bacteria in hospital.