990株临床非发酵菌的种群分布及耐药谱分析

目的了解某院临床标本分离的非发酵菌菌种分布及耐药谱,为临床用药提供依据。方法回顾性分析该院2004年1月-2008年12月临床各科室送检标本分离的990株非发酵菌资料。结果 990株非发酵菌分为11个菌属,其中以不动杆菌属细菌最多,占43.43%(430/990);假单胞菌属和窄食单胞菌属次之,分别为34.75%(344/990)和10.71%(106/990)。分离最多的前4种菌依次为铜绿假单胞菌(29.19%)、洛菲不动杆菌(20.61%)、醋酸钙-鲍曼不动杆菌复合种(13.74%)和嗜麦芽窄食单胞菌(10.71%)。标本中以痰液分离菌数最多,占79.80%(790/990),其次为咽拭子7.88%(78/990)、体液6.87%(68/990)。5年来,铜绿假单胞菌对替卡西林、头孢西丁、头孢噻肟、亚胺培南、奈替米星、复方磺胺甲(口恶)唑、培氟沙星、庆大霉素、呋喃妥因和妥布霉素的耐药率变化显著(P0.005或P0.05),耐药率30%的抗菌药物有头孢他啶和亚胺培南;不动杆菌属对阿莫西林/克拉维酸、庆大霉素、妥布霉素和复方磺胺甲(口恶)唑的耐药率变化显著(P0.005或P0.05),耐药率30%的抗菌药物有替卡西林、亚胺培南和奈替米星。结论非发酵菌为医院感染的主要病原菌,对常用抗菌药物的耐药率高,且多重耐药现象严重,应定期监测细菌变迁和耐药性变化,指导临床合理用药。

Distribution and antimicrobial resistance of 990 nonfermentative bacteria strains isolated from clinic

Objective To realize the distribution and drug resistance of nonfermentative bacteria isolated from clinic, so as to provide reference for antimicrobial use in clinic. Methods Data of 990 strains of nonfermentative bacteria isolated from clinical departments between January, 2004 and December, 2008 were analyzed retrospectively. Results Nine hundred and ninety nonfermentative bacteria strains were divided into 11 genera, most were Acinetobacter spp. , which accounting for 43. 43% （430/990）; the next were Pseudomonas spp. and Stenotrophornonas spp. , which was 34. 75% （344/990） and 10. 71% （106/990） respectively. The most common isolated bacteria were Pseudomonas aeruginosa （29. 19%）, Acinetobacter lwoffii （20. 61 %）, Acinetobacter calcoaceticus-baumannil complex （13.74%） and Stenotrophornonas maltophilia （10. 71%）. Most strains were isolated from sputum, which accounting for 79. 80% （790/990）, the next were throat swab and body fluid, which was 7. 88% （78/99（I） and 6. 87% （68/990） respectively. During the recent 5 years, the difference in drug resistance of Pseudomonas aeruginosa to ticareillin, cefoxitin, cefotaxime, imipenem, netilmicin, trimethoprim/sulfamethoxazole, pefloxacin, gentamyein, nitrofurantoin and tobramycin were significant （P〈0. 005 or P〈0. 05）, drug resistant rates 〈 30% were eeftazidine and imipenem; the change in drug resistance of Acinetobacter spp. to amoxieillin/clavulanic acid, gentamycin, tobramycin and trimethoprim/sulfamethoxazole were significant （P〈0. 005 or P〈0. 05）, drug resistant rates 〈30% were ticarcillin, imipenem and netilmicin. Conclusion Nonfermentative bacteria are main pathogens in nosocomial infection, drug resistant rates to commonly used antimicrobial agents are high, and multidrug resistance are serious, periodical monitor of change in bacteria and drug resistance should be carried out to guide rational use of antimicrobial agents in clinic.