嗜麦芽窄食单胞菌耐药性分析

Drug resistance analysis of Stenotrophomonas maltophilia

目的分析该院患者分离的嗜麦芽窄食单胞菌对抗菌药物的耐药性,为临床合理使用抗菌药物提供依据。方法收集该院2014-2015年临床非重复嗜麦芽窄食单胞菌32株,采用液体稀释法自动化仪器法进行细菌药敏试验,按照美国临床实验室标准化协会(CLSI)2017年版标准判读药敏试验结果。结果32株嗜麦芽窄食单胞菌来源于痰液27株(84.38%),血液2株(6.25%),尿液2株(6.25%),分泌物1株(3.12%);科室主要分布于干部病房呼吸内科5株(15.63%),干部病房重症监护室5株(15.63%),呼吸内科4株(12.50%),重症监护室3株(9.38%)等;头孢他啶耐药株19株(59.37%),复方磺胺甲噁唑耐药株2株(6.25%),替卡西林/棒酸耐药株9株(28.13%),左氧氟沙星耐药株3株(9.38%)。对其中18株进行米诺环素、头孢哌酮/舒巴坦、替加环素药敏试验检测,检出米诺环素耐药株1株(5.56%),头孢哌酮/舒巴坦耐药株2株(11.11%),替加环素耐药株2株(11.11%)。结论嗜麦芽窄食单胞菌主要分布于呼吸科及重症监护室,主要分离于痰液,对CLSI推荐的甲氧苄啶-复方磺胺甲噁唑、左氧氟沙星和米诺环素耐药率低,替加环素及左氧氟沙星敏感率高。临床需要根据药敏试验结果合理选用抗菌药物。

Objective To analyze the antimicrobial resistance of Stenotrophomonas maltophilia isolated from patients in the hospital,and to provide evidence for rational use of antimicrobial agents in clinical practice. Methods A total of 32 clinical non-repetitive Stenotrophomonas maltophilia strains were collected from the hospital from 2014 to 2015.The bacterial susceptibility test was carried out by liquid dilution automated instrument method.The drug sensitivity test results were interpreted according to CLSI 2017 standard. Results Among 32 strains of Stenotrophomonas maltophilia,27 strains (84.38%) were from the sputum,2 strains (6.25%) were from the blood,2 strains (6.25%) were from the urine,and 1 strain (3.12%) was from the secretions.The source departments were distributed in the Department of Respiratory Medicine in Cadre Ward (5 strains,15.63%),respiratory medicine (4 strains,12.5%) and intensive care unit (3 strains, 9.37 %).Among 32 strains,19 strains were ceftazidime resistant (59.37%),2 strains were compound sulfamethoxazole resistant (6.25%),9 strains were ticarcillin and clavula resistant (28.13%),and 3 strains were levofloxacin resistant (9.38%).A total of 18 strains were tested for susceptibility to minocycline,cefoperazone/sulbactam,tigecyclines,and 1 strain was minocycline resistant (5.56%),2 strains were cefoperazone/sulbactam resistant (11.11%) and 2 strains were tigecycline resistant (11.11%). Conclusion Stenotrophomonas maltophilia is mostly distributed in the respiratory department and ICU.It is mainly isolated from sputum,and has low drug resistance rate to trimethoprim-sulfamethoxazole,levofloxacin and minocycline which are recommended by CLSI.It is highly sensitive to tigecycline and levofloxacin.It is necessary to rationally select antibacterial drugs according to the results of drug susceptibility test.