多药耐药非发酵菌的临床分布特点及耐药性分析

Clinical distribution and drug resistance of multidrug-resistant non-fermenting bacteria

目的对医院多药耐药非发酵菌的临床分布特点以及耐药性进行分析,为治疗非发酵菌感染提供依据。方法对2009年2月-2013年2月医院送检的各类标本进行细菌鉴定,对非发酵菌的临床分布、组成、耐药性以及敏感率进行分析。结果共分离出病原菌3 488株,其中非发酵菌为682株,占19.6%;检出率最高的为痰液占27.6%,其次为伤口分泌物和脓液,分别占26.5%和15.4%;非发酵菌以铜绿假单胞菌、鲍氏不动杆菌、产碱假单胞菌为主,分别占41.8%、35.2%和8.1%;非发酵菌对氨苄西林/舒巴坦、第三代头孢类药物、磺胺甲噁唑/甲氧苄啶和氯霉素的耐药性较高,而对环丙沙星和左氧氟沙星多数敏感,其中铜绿假单胞菌对氨苄西林/舒巴坦、庆大霉素、头孢曲松和磺胺甲噁唑/甲氧苄啶的耐药率均>60.0%;鲍氏不动杆菌对氨苄西林/舒巴坦、哌拉西林、庆大霉素、头孢曲松、头孢哌酮、磺胺甲噁唑/甲氧苄啶和氯霉素的耐药率均>60.0%;产碱假单胞菌对庆大霉素和阿米卡星的耐药率均>60.0%。结论非发酵菌分布较广,且呈多药耐药趋势,应加强病房内病原菌及耐药性的监测。

OBJECTIVE To analyze the characteristics of clinical distribution and drug resistance of the multidrugresistant non-fermenting bacteria so as to provide guidance for the treatment of non-fermenting bacteria infections. METHODS The bacterial identification was performed for a variety of specimens that were submitted from Feb 2009to Feb 2013,then the clinical distribution,constituent ratios,drug resistance,and drug susceptibility rates of the non-fermenting bacteria were observed.RESULTS A total of 3488strains of pathogens have been isolated, among which there were 682（19.6%）strains of non-fermenting bacteria;27.6%of the strains were isolated from the sputum specimens,26.5%from the wound secretions,15.4%from the pus.Among the non-fermenting bacteria isolated,the Pseudomonas aeruginosa,Acinetobacter baumannii,and Pseudomonas alcaligenes were dominant,accounting for 41.8%,35.2%,and 8.1%,respectively.The non-fermenting bacteria were highly resistant to ampicillin-sulbactam,third-generation cephalosporins,sulfamethoxazole-trimethoprim,and chloromycetin but were highly susceptible to ciprofloxacin and levofloxacin;the drug resistance rates of the P.aeruginosato ampicillin-sulbactam,gentamycin,ceftriaxone,and sulfamethoxazole-trimethoprim were more than 60.0%;the drug resistance rates of the A.baumannii to ampicillin-sulbactam,piperacillin,gentamycin,ceftriaxone,cefoperazone, sulfamethoxazole-trimethoprim,and chloromycetin were more than 60.0%;the drug resistance rates of the P.alcaligenes to gentamycin and amikacin were more than 60.0%.CONCLUSION The non-fermenting bacteria are widely distributed and show multidrug-resistant trend,thus the monitoring of the pathogens from the ward and the drug resistance should be enhanced.