粘质沙雷菌在我院ICU的感染现状及耐药性变迁

Infection status and changes of drug resistance of serratia marcescens in ICU in our hospital

目的：了解近三年来粘质沙雷菌在我院重症监护病房（Icu）的感染状况及耐药率。方法：将2013—2015年送检合格标本中分离的感染菌分别进行汇总，对粘质沙雷的感染状况及耐药率（剔除同一患者相同结果）进行统计。结果：在ICU病房，连续三年粘质沙雷菌的检出量超过鲍曼不动杆菌，而成为仅次于铜绿假单胞的第二位感染菌。氨苄西林、氨苄西林／舒巴坦、氨曲南、头孢曲松、环丙沙星耐药率持续〉70％；阿米卡星、头孢他啶、头孢替坦、哌拉西林／他唑巴坦、复方新诺明、亚胺培南、美罗培南耐药率均低于30％；头孢替坦、头孢吡肟、亚胺培南、左氧氟沙星在2015年的耐药率较2013年、2014年有不同程度的升高。阿米卡星、庆大霉素、妥布霉素则呈下降趋势。结论：作为肠杆菌科细菌的粘质沙雷菌，在ICU不仅感染率高，而且耐药率也较高，尤其对于治疗产超广谱β-内酰胺酶（ESBLs）及AmpC酶等多重耐药菌株最有效药物之一的亚胺培南，其耐药率呈不同程度增长，应引起高度重视。

Objective： To investigate the infection status and drug resistant rate of Serratia marcescens in ICU of our hospital in recent three years.Methods： The infectious bacteria isolated from qualified samples tested from 2013-2015 were collected. The infection stares and drug resistant rate of Serratia marcescens were counted （excluding the same results from the same patients） .Results： The detectable amount of Serratia marcescens was at the second place in the ICU for three consecutive years, only second to the Acinetobacter baumannii. The resistant rates for Ampicillin , Ampicillin / Shubatan, aztreonam, ceftriaxone, ciprofloxacin were continuously over 70%. The resistant rates for Amikacin, ceftazidime, cefotetan, piperacillin / tazobactam, cotrimoxazole, imipenem, meropenem were continuously under 30%. The resistant rates for Cefotetan, cefepime, imipenem, levofloxacin in 2015, were higher than that in 2013 and 2014 with different degrees. And the resistant rates for Amikacin, gentamicin, tobramycin decreased. Conclusion： The Serratia marcescens, as one of the enterobacteriaceae, not only have high infection rate in ICU, but also high drug resistant rate. Especially for imipenem, one of the most effective drugs to multi drug resistant strains which producing extended spectrum beta lactamases （ESBLs） and AmpC enzyme, the drug resistant rate increased with different degrees. This situation should be paid great attention to.