肿瘤医院感染患者非发酵菌的分布及耐药性分析

Distribution and drug resistance analysis of non-fermentation bacteria of infected patients in tumor hospital

目的了解肿瘤医院非发酵菌的临床分布及耐药特征,为临床合理使用抗菌药物提供依据。方法对2009-2011年医院肿瘤患者临床送检各类标本检出的病原菌采用法国生物梅里埃公司VITEK-32鉴定仪进行鉴定,药敏试验用K-B纸片扩散法,按美国临床实验室标准化研究所2010年标准判断结果,采用WHONET 5.4软件进行数据统计分析。结果 2009-2011年共分离出非发酵菌1 175株,其中铜绿假单胞菌626株占53.28%,嗜麦芽寡养单胞菌255株占21.70%,鲍氏不动杆菌186株,占15.83%;1 175株非发酵菌主要分离自痰液、分泌物及无菌体液,分别占72.85%、10.89%和8.77%;在检出的1 175株非发酵菌中ICU 364株占30.97%、胸外科305株占25.96%、放疗科235株占20.0%、其他科室271株占23.06%;3年医院铜绿假单胞菌对常用抗菌药物的耐药率均<37.0%,但对亚胺培南、美罗培南、头孢他啶的耐药率呈逐年上升趋势,尤其是亚胺培南和美罗培南的耐药率已达32.7%和30.5%,鲍氏不动杆菌对常用抗菌药物均产生了较严重的耐药性,多数耐药率>90.00%,对亚胺培南和美罗培南的耐药率分别为75.3%和73.8%。结论非发酵菌对常用抗菌药物有较高的耐药率,耐药机制多样复杂,临床在治疗非发酵菌感染时应结合实验室药敏结果合理使用抗菌药物,有效地控制医院感染。

OBJECTIVE To understand of the clinical distribution and drug resistance features of non-fermentative bacteria in tumor hospital so as to provide references for rational clinical use of antibacterial drugs.METHODS The VITEK-32appraisal instrument produced by French BioMerieux Company was used to identify the pathogenic bacteria detected from various samples sent by the patients with tumor in the hospital.The drug sensitive test was conducted using the K-B disk diffusion method.The results were judged according to the 2010Standard of Clinical and Laboratory Standard Institute.The data were analyzed using WHONET5.4software.RESULTS A total of 1175strains of non-fermentative bacteria were isolated from various clinical specimens from 2009to 2011,in which there were 626strains of Pseudomonas aeruginosa,which accounted for 53.28%,255strains of Stenotrophomonas maltophilia,which accounted for 21.7%and 186strains of Acinetobacter baumannii,which accounted for 15.83%.The 1175strains of non-fermentation bacteria were mainly isolated from sputum,secreta,and sterile body liquid,accounting for 72.85%,10.89% and 8.77%respectively.Among 1175detected strains of nonfermenting bacteria,364strains from ICU accounted for 30.97%.305strains from thoracic surgery accounted for 25.96%,235strains from radiotherapy department accounted for 20.0%,and 271strains from other departments accounted for 23.06%;in 3years,the hospital Pseudomonas aeruginosa resistant rate to commonly used antibiotics was less than 37.0%,but the resistant rate to imipenem,meropenem,ceftazidime showed an upward trend,especially for imipenem and meropenem,whose resistance rates reached 32.7% and 30.5%.A. baumannii resistance to commonly used antibiotics produced serious drug resistance,with the majority of drug-resistant rate at over 90.00% and resistance rates to imipenem and meropenem were 75.3% and 73.8%,respectively.CONCLUSIONThe drug resistance of non-fermentative bacteria to frequently-used antibiotic is higher and its resistance mechanisms are various and complex.The antibiotics should be rationally chosen according to the result of the drug susceptibility test in the cure process of non-fermentative infection so as to effectively control nosocomial infection.