奇异变形菌分布与耐药性分析

Distribution and drug resistance of Proteus mirabilis

目的了解医院奇异变形菌感染分布情况及耐药变迁,为临床合理使用抗菌药物提供参考。方法对2005年1月-2015年12月医院分离的奇异变形菌的分布及耐药情况进行统计分析。结果 11年非重复分离奇异变形菌共1442株,占所有住院患者非重复分离肠杆菌科细菌的6.87%,且分离率波动不大;主要分离于痰、尿、分泌物及血标本等,分别占32.11%、34.81%、14.42%和1.25%;药敏结果显示奇异变形菌对哌拉西林、哌拉西林/他唑巴坦、头孢替坦、头孢他啶、头孢吡肟、氨曲南、亚胺培南、美洛培南、阿米卡星及头孢哌酮/舒巴坦等的耐药率较低,分别为9.42%、1.09%、1.65%、6.42%、7.54%、3.96%、1.43%、0.14%、5.83%和4.06%,可作为经验首选药;氨苄西林、头孢唑林和磺胺甲噁唑/甲氧苄啶耐药率较高,分别为52.56%、58.37%和51.67%,需加强临床使用规范;从呼吸道分离的奇异变形菌对头孢替坦、头孢他啶及阿米卡星的耐药率高于从尿液分离的奇异变形菌,而对环丙沙星的耐药率低于从尿液中分离的奇异变形菌,均具有统计学差异。结论加强医院感染细菌学的检测和动态分析,对制定有效感染控制措施及杜绝感染暴发具有重要意义。

OBJECTIVE To investigate the distribution and drug resistance of Proteus mirabilis so as to provideguidance for reasonable clinical use of antibiotics.METHODS The distribution and drug resistance of the P.mirabilis strains that were isolated from the hospital from Jan 2005 to Dec 2015 were statistically analyzed.RESULTS A total of 1442 strains of nomrepetitive P.mirabilis were isolated in the 11 years,accounting for 6.87% among the non-repetitive Enterobacteriaceae strains isolated from all of the hospitalized patients,and the isolation rate was stable.Among the isolated P.mirabilis strains,32.11 % were isolated from sputum specimens,34.81 % were isolated from urine specimens,14.42% were isolated from secretions,and 1.25% were isolated from blood specimens.The result of drug susceptibility testing showed that the drug resistance rates of the P.mirabilis to piperacillin,piperacillin-tazobactam,cefotetan,ceftazidime,cefepime,aztreonam,imipenem,meropenem,amikacin,and cefoperazone-sulbactam were 9.42%,1.09%,1.65%,6.42%,7.54%,3.96%,1.43%,0.14%,5.83%,and 4.06%,respectively,and the above antibiotics could be used as preferred antibiotics for empirical therapy.The drug resistance rates to ampicillin,cefazolin,and sulfamethoxazole-trimethoprim were 52.56%,58.37%,and 51.67%,respectively,and the standardized clinical use of the antibiotics should be intensified.The drug resistance rates of the P.mirabilis strains isolated from respiratory tract to cefotetan,ceftazidime,and amikacin were higher than those of the P.mirabilis strains isolated from the urine specimens,however,the drug resistance rate of the P.mirabilis strains isolated from respiratory tract to ciprofloxacin was lower than that of the P.mirabilis strains isolated from the urine specimens,and there was significant difference.CONCLUSION It is of great significance to strengthen the bacteriological detection of nosocomial infections so as to formulate effective measures for control of the infections and prevent the outbreak and prevalence of the infections.