褪色沙雷菌的医院感染分布与耐药性分析

目的 了解褪色沙雷菌在医院感染的临床分布和在ICU与非ICU的耐药性,为临床合理选择和应用抗菌药物提供依据.方法 用K-B法对临床分离出的156株褪色沙雷菌进行体外药物敏感试验并统计分析,同时检测其β-内酰胺酶.结果 分离培养的156株褪色沙雷菌在科室分布,ICU 57株占36.5％、呼吸科52株占33.3％、神经内科28株占17.9％、其他科室19株占12.2％；对亚胺培南、头孢哌酮/舒巴坦的医院平均耐药率分别为3.8％和1.9％,对氨苄西林、头孢唑林、阿莫西林/克拉维酸的耐药率均＞90.0％；检测产AmpC酶菌21株,检出率为13.5％,产ESBLs菌18株,检测率为11.5％,同时产AmpC酶和ESBLs菌7株,检出率为4.5％.结论 ICU分离培养的褪色沙雷菌的耐药率显著高于非ICU分离培养的菌株；AmpC酶和ESBLs的3个表型的检出率ICU明显高于非ICU；褪色沙雷菌耐药机制复杂,对抗菌药物具有多药耐药性,临床应根据药敏试验结果合理选择抗菌药物.

Distribution and drug resistance of Serratia marcescens causing nosocomial infections

OBJECTIVE To explore the clinical distribution and drug resistance of Serratia marcescens causing nosocomial infections in the ICU and non-ICU so as to provide bases for reasonable use of antibiotics.METHODS The in vitro drug susceptibility testing was performed for 156 clinical isolates of S.marcescens by using KB method,β-lactamase was detected at the same time.RESULTS Of 156 strains of S.marcescens cultured and isolated,there were 57(36.5%) strains in ICU,52(33.3%) strains in respiratory department,28(17.9%) strains in neurology department,and 19(12.2%) strains in other departments;the average drug resistance rates to imipenem and cefoperazone/sulbactam were 5.1% and 1.9%,the drug resistance rates to ampicillin,cefazolin,and amoxicillin/clavulanic acid were higher than 90.0%;there were 21 strains of Ampc enzyme-producing S.marcescens detected with the detection rate of 13.5%,18 strains of ESBLs-producing S.marcescens with detection rate of 11.5% and 7 strains of both Ampc enzyme and ESBLs-producing S.marcescens with detection rate of 4.5%.CONCLUSION The drug resistance rate of S.marcescens strains isolated from ICU is significantly higher than those isolated from non-ICUs;the detection rates of the three phenotypes of Ampc and ESBLs are higher in ICU than in non-ICUs;the drug resistant mechanism of S.marcescens is complex,and S.marcescens is resistant to multiple antibiotics,it is necessary to reasonably choose antibiotics on the basis of drug susceptibility testing.