嗜麦芽窄食单胞菌的分布及其药敏分析

Distribution and antimicrobial susceptibility analysis of Stenotrophomonas maltophilia

目的了解本地区嗜麦芽窄食单胞菌的分布及药敏特点,为指导临床合理用药提供依据。方法收集2014年-2016年温州地区各家医院临床各类标本中分离的嗜麦芽窄食单胞菌900株进行分析,了解其标本来源的分布,采用K-B纸片扩散法测试抗菌药物(米诺环素、复方新诺明、左氧氟沙星、头孢哌酮/舒巴坦)的敏感情况。结果 900株嗜麦芽窄食单胞菌在痰液标本中检出率最高,有713株,占79.22%;其次为创面渗液47株(5.22%)、血液30株(3.33%)、导管16株(1.78%)、引流液16株(1.78%)、尿液16株(1.78%)、脓液15株(1.67%)。在痰液标本中,嗜麦芽窄食单胞菌对米诺环素、复方新诺明、左氧氟沙星、头孢他啶和头孢哌酮/舒巴坦的敏感率分别为95.87%、94.31%、87.48%、56.76%、45.66%。结论米诺环素、复方新诺明和左氧氟沙星对嗜麦芽窄食单胞菌仍保持非常强的体外抗菌活性,适合作为一线用药;头孢哌酮/舒巴坦、头孢他啶对该菌耐药率呈逐年上升趋势,临床治疗应根据药敏结果合理选用抗菌药物。

Objective To understand the distribution and antimicrobial susceptibility of Stenotrophomonas maltophilia in Wenzhou,so as to provide clinical basis for the reasonable use of antibiotics. Methods 900 strains of Stenotrophomonas maltophilia isolated from various clinical specimens in Wenzhou area from 2014 to 2016 were collected and analyzed,and to understand the distribution of the specimens source. The drug resistance of antimicrobial agents of minocycline,cotrimoxazole,levofloxacin,cefoperazone/sulbactam were tested by K-B method and the MIC value of ceftazidime was determined by E-test.Results Among the 900 stains of Stenotrophomonas maltaphilia,713 strains were detected from sputum samples with the highest detection rate,accounting for 79. 22%. 47 strains came from wound exudate（ 5. 22%）,30 strains from blood（ 3. 33%）,16 strains from catheter（ 1. 78%）,16 strains from drainage fluid（ 1. 78%）,16 strains from urine（ 1. 78%）,15 strains from pus（ 1. 67%）. In sputum specimens,the susceptibility rates of 713 strains of Stenotrophomonas maltophilia to minocycline,cotrimoxazole,levofloxacin,ceftazidime and cefoperazone/sulbactam were 95. 87%,94. 31%,87. 48%,56. 76% and 45. 66%,respectively. Conclusion Minocycline,cotrimoxazole and levofloxacin were still very strong in vitro antibacterial activity against Stenotrophomonas maltophilia and were suitable as first-line drugs. The resistance rate of cefoperazone/sulbactam and ceftazidime on the bacteria increases annually,so the clinical treatment should be based on drug susceptibility rational selection of antimicrobial drugs.