重症医学科嗜麦芽窄食单胞菌的分布及耐药性分析

Analysis of the distribution and drug resistance of Stenotrophomonas maltophilia from Intensive Care Unit

目的分析泰安市中心医院重症医学科嗜麦芽窄食单胞菌的分布及耐药性,为临床合理使用抗菌药物及控制医院感染提供依据。方法采用Microscan Walk Away 96 Plus全自动微生物鉴定及药敏系统进行菌株鉴定和药敏试验,对2012年10月至2013年12月本院重症医学科分离的嗜麦芽窄食单胞菌分布情况及耐药性进行回顾性分析。结果临床标本共分离出嗜麦芽窄食单胞菌65株,其中50岁以上患者占60.0%(39/65);主要分离自痰液,占90.8%(59/65),其他依次为分泌物4.6%(3/65)、血液1.5%(1/65)、胸水1.5%(1/65)和尿液1.5%(1/65);对替卡西林/克拉维酸、头孢他啶、左氧氟沙星和磺胺甲噁唑/甲氧苄啶耐药率依次为61.5%(40/65)、87.7%(57/65)、7.7%(5/65)和0(0/65),敏感率依次为13.8%(9/65)、7.7%(5/65)、90.8%(59/65)和100%(65/65)。结论嗜麦芽窄食单胞菌主要引起呼吸道感染,对替卡西林/克拉维酸及头孢他啶耐药严重,对磺胺甲噁唑/甲氧苄啶最敏感,临床上应根据本地区的流行病学特点合理选用抗菌药物。

Objective To investigate the distribution and drug resistance of Stenotrophomonas maltophilia in Intensive Care Unit（ICU）, and provide the basis for the clinical treatment and control nosocomial infection. Methods The bacterial identification and susceptibility test were done by Microscan Walk Away 96 Plus automated microbial identification system. The distribution and drug resistance of Stenotrophomonas maltophilia isolated from ICU from October 2012 to December 2013 in our hospital were analyzed, retrospectively. Results Total of 65 strains of Stenotrophomonas maltophilia were isolated, among which, patients over 50 years accounted for 60.0%（39/65）; mainly from sputum, accounting for 90.8%（59/65）, followed by secretion of 4.6%（3/65）, blood of 1.5%（1/65）, pleural effusion of 1.5%（1/65） and urine of 1.5%（1/65）. The resistance rates of Stenotrophomonas maltophilia to ticarcillin/clavulanic, ceftazidime, levofloxacin and sulfamethoxazole/trimethoprim were 61.5%（40/65）, 87.7%（57/65）, 7.7%（5/65） and 0（0/65）, respectively; and the sensitive rates were 13.8%（9/65）, 7.7%（5/65）, 90.8%（59/65） and 100%（65/65）, respectively. Conclusions Stenotrophomonas maltophilia mainly caused respiratory infection. Drug resistance to ticarcillin/clavulanic and ceftazidime were severe, and sulfamethoxazole/trimethoprim was most sensitive. The proper antibiotics should be chosen according to the epidemiological characteristics of the local.