我院2004—2016年3种非发酵革兰氏阴性杆菌耐药性分析

Analysis of Drug Resistance of 3 Non-fermentative Gram-negative Bacilli in Our Hospital during 2004-2016

目的:为临床合理选用针对非发酵革兰氏阴性杆菌的抗菌药物提供参考。方法:收集青岛大学附属医院(以下简称"我院")2004年1月-2016年12月临床分离的铜绿假单胞菌(PA)、鲍曼不动杆菌(AB)、嗜麦芽窄食单胞菌(SM)的病原学资料,回顾性分析其对常用抗菌药物的耐药情况。结果:共检出PA 15 587株、AB 7 446株、SM 2 950株。PA对常用抗菌药物的耐药率虽有波动,但整体呈下降趋势;除亚胺培南外,PA对其他常用抗菌药物的耐药率均明显下降,其中对阿米卡星、庆大霉素的耐药率分别降至4.60%、7.48%。AB对大部分常用抗菌药物的耐药率均超过了40%,但对替加环素较为敏感(耐药率为0~4.03%)。SM对头孢哌酮钠舒巴坦钠的耐药率由2004年的3.03%上升至2016年的39.01%,但对复方磺胺甲噁唑、米诺环素、左氧氟沙星较为敏感。结论:我院检出的非发酵革兰氏阴性杆菌以PA为主。PA对大部分抗菌药物的耐药率呈下降趋势,AB的耐药情况严峻,SM对头孢哌酮钠舒巴坦钠的耐药率呈上升趋势。对上述3种非发酵革兰氏阴性杆菌敏感的药物包括阿米卡星、替加环素、米诺环素等,临床应根据药敏试验结果合理选用。

OBJECTIVE：To provide reference for rational selection of antibiotics against non-fermentative Gram-negative bacilli in clinic. METHODS：Etiological data of clinical isolated Pseudomonas aeruginosa（PA）,Acinetobacter baumanii（AB）and Stenotrophomonas maltophilia（SM）were collected from the Affiliated Hospital of Qingdao University（called＂our hospital＂for short） during Jan. 2004-Dec. 2016. Drug resistance of them to commonly used antibiotics was analyzed retrospectively.RESULTS：Totally 15 587 strains of PA,7 446 strains of AB and 2 950 strains of SM were detected. Resistance rates of PA to commonly used antibiotics fluctuated but were in a decreasing tendency. Except for imipenem,resistance rates of PA to commonly used antibiotics decreased significantly,and resistance rates of PA to amikacin and gentamicin decreased to 4.60% and 7.48%,respectively. Resistance rates of AB to most commonly used antibiotics were more than 40%,but it was sensitive to tigecycline（drug resistance of 0-4.03%）. Resistance rates of SM to cefoperazone sodium and sulbactam sodium increased from 3.03% in 2004 to 39.01% in 2016,but it was sensitive to sulfamethoxazole,minocycline and levofloxacin. CONCLUSIONS：Non-fermentative Gram-negative bacilli detected in our hospital are mainly PA. Resistance rate of PA to most of the antibiotics is declining;drug resistance of AB is severe;resistance rates of SM to cefoperazone sodium and sulbactam sodium show increasing tendency. Above 3 non-fermentative Gram-negative bacilli are sensitive to amikacin,tegocycline and minocycline. Clinical selection should be based on the results of drug sensitivity test.