427株黏质沙雷菌临床分布及耐药性

Clinical distribution and antimicrobial resistance of 427 Serratia marcescens isolates

目的：了解临床分离的黏质沙雷菌临床分布及耐药情况，为临床合理使用抗菌药物、预防和控制感染提供依据。方法对某院2012年1月1日—2015年12月31日临床分离的427株黏质沙雷菌进行分析，采用纸片扩散法检测其对常用抗菌药物的敏感性。结果427株黏质沙雷菌标本来源以呼吸道为主（70．26％），主要为痰（64．87％）；科室分布主要为重症监护病房（ICU，19．44％），其次为中西医结合科（15．46％）和康复科（13．58％）。黏质沙雷菌对头孢哌酮／舒巴坦、厄他培南、头孢吡肟、头孢他啶、阿米卡星、亚胺培南、左氧氟沙星和哌拉西林／他唑巴坦的耐药率均＜10％；对环丙沙星、庆大霉素、妥布霉素、头孢曲松、复方磺胺甲口恶唑和氨曲南的耐药率为10％～30％。4年间耐药率变化有统计学意义（P ＜0．05）的有头孢哌酮／舒巴坦、环丙沙星、头孢曲松、阿米卡星、氨曲南和复方磺胺甲口恶唑；2012—2013年黏质沙雷菌对头孢哌酮／舒巴坦、环丙沙星、头孢曲松、氨曲南和复方磺胺甲口恶唑耐药率明显增加，之后耐药率趋于平稳；对头孢哌酮／舒巴坦则耐药性降低。结论黏质沙雷菌对大部分常用抗菌药物的敏感性较好，但耐药性有增加的趋势；其中厄他培南、头孢他啶、左氧氟沙星和哌拉西林／他唑巴坦敏感率高，可作为临床治疗相关感染的经验用药。

Objective To understand clinical distribution and antimicrobial resistance of clinically isolated Serratia marcescens（S .marcescens ）,and provide basis for rational use of antimicrobial agents,as well as prevention and control of infection.Methods 427 S .marcescens strains isolated between January 1 ,2012 and December 31 ,2015 were analyzed,antimicrobial susceptibility testing were performed by disk diffusion method.Results 427 S . marcescens strains were mainly from respiratory tract （70.26%）,among which the majority were from sputum （64.87%）.S .marcescens were primarily from intensive care unit（ICU,19.44%）,department of integrated tradi-tional Chinese and Western medicine（15.46%）as well as rehabilitation department （13.58%）.The resistance rates of S .marcescens to cefoperazone/sulbactam,ertapenem,cefepime,ceftazidime,amikacin,imipenem,levofloxacin, and piperacillin/tazobactam were all〈10%;resistance rates to ciprofloxacin,gentamicin,tobramycin,ceftriaxone, sulfamethoxazole/trimethoprim （SMZ/TMP）,and aztreonam were 10%-30%.Difference in the resistance rates of S .marcescens to cefoperazone/sulbactam,ciprofloxacin,ceftriaxone,amikacin,aztreonam,and SMZ/TMP dur-ing 4 years were statistically significant （P 〈0.05）.In 2012-2013,resistance rates of S .marcescens to cefopera-zone/sulbactam,ciprofloxacin,ceftriaxone,aztreonam,and SMZ/TMP increased obviously,then resistance rates＆nbsp;tend to be stable,while resistance rates to cefoperazone/sulbactam decreased.Conclusion Susceptibility of S.marcescens to most antimicrobial agents are high,but resistance had increasing tendency;susceptible rates of S .marcescens to ertapenem,ceftazidime,levofloxacin,and piperacillin/tazobactam are all high,and can be used as the empirical medication for the treatment of related infection.