常见非发酵革兰阴性杆菌的体外抗菌活性分析

In vitro Activity of Antibiotics to the Common Nonfermenters

目的 调查常用抗生素对临床常见非发酵革兰阴性杆菌的体外抗菌活性 ,为临床用药提供参考。方法 分析 2 0 0 1年 1月～ 2 0 0 2年 12月本院临床标本中分离出的铜绿假单胞菌、鲍氏不动杆菌和嗜麦芽寡养单胞菌对常用抗生素的耐药性 ,细菌鉴定及药敏试验采用VITEK 6 0全自动微生物鉴定仪。结果 检出非发酵菌6 99株 ,居前 3位的是铜绿假单胞菌 (36 5株 )、鲍氏不动杆菌 (14 1株 )和嗜麦芽寡养单胞菌 (76株 ) ,三者占非发酵菌的 83% ,对哌拉西林 /他唑巴坦的抗菌活性最强 ,敏感率 70 0 % ,其次是头孢他啶、亚胺培南、左氧氟沙星、环丙沙星和替卡西林 /克拉维酸 ,敏感率分别是 5 7 8%、5 5 4 %、5 5 0 %、5 2 0 %和 5 0 0 % ,其余抗生素敏感率都<5 0 0 % ,一代头孢菌素对常见非发酵菌无效 ,嗜麦芽寡养单胞菌对亚胺培南天然耐药。结论 常见非发酵菌是一类多重耐药且耐药性较高的细菌 ,治疗上最好根据药敏选用抗生素 ,并结合其耐药特点联合应用具有协同作用的不同类型抗生素。

OBJECTIVE To investigate the in vitro activity of the frequently used antibiotics to the common nonfermenters. METHODS To study the resistance of the isolated strains of Pseudomonas aeruginosa, Acinetobacter baumannii and Stenotrophomonas maltophilia in our hospital from Jan 2001 to Dec 2002. Bacteria identification and antibiotic susceptibility testing were performed by the VITEK auto-microbic system. RESULTS A total of 699 strains of nonfermenters were detected. The dominant strains were P. aeruginosa(365 strains), A. baumannii (141 strains )and S. maltophilia(76 strains).These strains accounted for 83% among the nonfermenters. The in vitro activity of piperacillin/tazobactam was the most active, whose susceptibility rate was 58%, followed by ceftazidime, imipenem, levofloxacin, ciprofloxacin, whose susceptibility rates were 55%, 55%, 52%, 50%, respectively. The other antibiotics' susceptibility rates were less than 50%. The first generation cephalosporins were ineffective to the common nonfermenters. S. maltophilia was originally resistant to imipenem. CONCLUSIONS The common nonfermenters are multiple-resistant to antibiotics and display higher levels of antibiotic resistance. It is suggested that antibiotics be used under the guidance of antibiotic susceptibility testing. Different kinds of antibiotics with synergies can be combined to use according to the resistant mechanism of the bacteria.