连续四年临床常见非发酵菌的感染分布及耐药性变迁分析

Analysis of clinical non fermenters infection distribution and drug-resistance transition in four years

目的了解解放军第202医院临床常见非发酵菌在医院感染中的分布及耐药性变迁,为临床合理用药提供依据。方法对2008年1月至2011年12月临床送检各类标本进行分离培养,采用VITEK2-compact全自动微生物仪进行菌株鉴定,用K-B纸片琼脂扩散法检测抗菌药物的敏感性。结果共分离3种常见非发酵革兰阴性杆菌2 290株,其中铜绿假单胞菌1 342株,鲍曼不动杆菌597株,嗜麦芽窄食单胞菌351株;痰液标本中检出最多(73.4%),其次为创面分泌物(11.5%);主要分布在老年病科(28.8%),肿瘤科(20.0%),神经内科(14.8%),呼吸内科(11.3%),ICU(10.2%)。连续4年3种非发酵菌耐药率呈逐年上升趋势,到2011年对于铜绿假单胞菌引起严重感染,首选头孢哌酮/舒巴坦、美洛培南。鲍曼不动杆菌对亚胺培南、美罗培南、头孢哌酮/舒巴坦、米诺环素的耐药率分别为17.1%、10.1%、8.2%、5.3%,可作为治疗鲍曼不动杆菌引起严重感染最为有效的药物。对于嗜麦芽窄食单胞菌,米诺环素、左氧氟沙星和复方新诺明药仍保持较好的敏感性。结论非发酵菌检出率逐年增多,耐药率逐年上升。及时了解和掌握本地区非发酵菌的流行现状及耐药性特征,有利于临床合理选择抗菌药物,提高治疗效果,减少耐药菌株的产生与传播。

Objective To provide evidence for clinical rational drug usage,we studied the distribution and drug-resistance transition of clinically common non fermenters infection in 202 hospital of PLA.Methods All clinical examples from January 2008 to December 2011 were isolated and cultured,These samples were identified microbial strains by VITEK2-compact fully automatic apparatus.The K-B paper AGAR diffusion method was used in detecting the sensitivity of antimicrobial agents.Results We had isolated totally 2 290 strains of Gram-negative nonfermenters,including pseudomonas aeruginosa（1 342 strains）,acinetobacter baumannii（597 stains） and stenotrophomonas maltophilia（351 strains）.Most of them were detected in sputum（73.4%）,the second of which was in exudates of wound surface.Endemic area were mainly in geriatrics department（28.8%）,oncology department（20.0%）,neurology department（14.8%）,respiratory department（11.3%）,and intensive care unit（ICU）（10.2%）.By analyzing the data in continuous four years,we found that drug resistance rate is increasing year by year.By the the end of 2011,we still recommend cefoperazone or sulbactamis as first choice in infection of pseudomonas aeruginosa.Drug resistance rate of acinetobacter baumannii to imipenem,meropenem,cefoperazone,mynocycline is 17.1% 、10.1% 、8.2% 、5.3% respectively.These drugs can be used to control acinetobacter baumannii infection.In stenotrophomonas maltophilia infection,this pathogen is still sensitive to mynocycline,levofloxacin,sulfamethoxazole trimethoprim.Conclusion The rate of prevalence of nonfermenters is increasing year after year,and the mechanism of drug resistance is still complicated.The understanding of local nonfermenters epidemiology and specific of drug-resistance in time is not only beneficial for both rational drug use of antibiotics and improving treatment effect,but also good for decrease producing and transmission of drug resistance strains.