2008—2012年安徽省3154株非发酵菌分布特点及耐药分析

Analysis of antibiotic resistance and clinical distribution of 3,154 stains of non-fermentative isolates in Anhui province from 2008 to 2012

目的了解安徽地区医院感染非发酵革兰阴性菌的分布特点及耐药状况,为临床抗感染治疗提供依据。方法抽取安徽省40家参加医院2008年至2012年,每年9月份临床分离的非发酵革兰阴性菌,采用国际标准琼脂糖平皿二倍稀释法进行体外药物敏感试验,用最低抑菌浓度(MIC值)表示抗菌药物的抗菌活性,并按2012年美国临床和实验标准化研究所(CSLI)指导原则的标准计算细菌对抗菌药物的耐药率。使用WHONET5.6分析软件分析数据。结果共检测安徽省内3154株非发酵菌,占临床分离总数的27%。其中,占首位的是铜绿假单胞菌,其次为鲍曼不动杆菌和嗜麦芽寡养单胞菌,分别占50.1%、36.8%和6.7%。非发酵菌感染部按检出率高低依次为:下呼吸道、伤口创面、泌尿生殖道、胸腹腔,上述4种标本占整个临床分离株的89.2%。病区分布主要为呼吸内科(48.7%),其次为重症监护室(20.2%)、烧伤科和神经内科分别占19.8%和14.3%。药敏结果显示,安徽地区非发酵菌对碳青霉烯类药物耐药率逐年升高,对头孢菌素类、青霉素类、喹诺酮类药物呈现高度耐药,并且多重耐药和泛耐药情况严重。结论近5年来,安徽地区非发酵菌的分离率较高,多重耐药现象严重,应重视非发酵菌的感染情况并做好对其的耐药性监测。

Objective To explore the clinical characteristics and the drug resistance of non-fermenting gramnegative bacteria in Anhui province, and to provide the scientific evidence for clinnically reasongable ues of antibiotics. Methods Drawn the samples from 2008 to 2012, a total of 3,154 strains of non-fermenting gramnegative bacterias from 40 hospitals in Anhui province. Using the international standard plate dilute method to assay MIC as indicator representing the antibacterial activity of antimicrobial agents. The resistant rate （R%）, intermediate rate （I%） and susceptibility rate （S%） of drugs were calculated according to thecriteria in guidelines of CSLI（2012）. WHONET 5.6 software were used to analyze the datas. Results 3,154 strains of non-fermenting gramnegative bacteria in Anhui province were tested. Account for 27% of isolates examined in clinical microbiology labratories. The top three of the isolation rate among 3,154 strains of non-fermenting gramnegative bacteria were P. aeruginosa, A. baumannii,S. maltophilia, accounting for 50.1%, 36.8% and 6.7%, respectively. Most of non-fermenting gram negative bacteria were isolated from sputum, wound, urine and drainage liquid. Departments of respiratory was the main endemic area, accounting for 48.7%, followed by ICU and departments of neurosurgery. The result showed that drug resistances of non-fermenting gramnegative bacteria to carbapenem were increased year by year, to most of the common antibiotics is high. Conclusion Non-fermenting gram negative bacteria had gained increasing antimicrobial resistance in Anhui province from 2008 to 2012. Which indicates that we should immediate to survey the clinical characteristics and drug resistance of non-fermenting gram negative bacteria in hospital, control the nosocomial infection and to guide empirical antimicrobial prescribing.