2010年中国CHINET嗜麦芽窄食单胞菌耐药性监测

目的了解国内不同地区14所医院2010年临床分离嗜麦芽窄食单胞菌对抗菌药物的耐药性。方法收集14所医院2010年临床分离嗜麦芽窄食单胞菌1 661株,按统一方案、采用统一的材料、K-B法和判断标准(CLSI 2010年版)进行嗜麦芽窄食单胞菌的耐药性监测。结果 1661株嗜麦芽窄食单胞菌住院患者分离株占97.5%;门诊患者分离株仅占2.5%。60岁以上的老年患者分离株占63.8%,<18周岁患者的分离株占4.8%。主要是痰液等呼吸道分泌物分离者占83.0%;分离自血液、胸腹水、关节腔液、脑脊液等无菌体液者占4.7%。该菌对甲氧苄啶-磺胺甲(?)唑、左氧氟沙星和米诺环素的耐药率分别为11.2%、10.7%和3.4%,对头孢哌酮-舒巴坦的耐药率为13.8%。尿液分离株对甲氧苄啶-磺胺甲(?)唑和头孢哌酮-舒巴坦的耐药率为21.6%和33.3%,高于其他标本分离株耐药率,P<0.01。结论嗜麦芽窄食单胞菌主要分离自住院患者及痰液等呼吸道标本中,且多见于≥60岁的老年患者。该菌对多数抗菌药物固有耐药,但对CLSI推荐的甲氧苄啶-磺胺甲(?)唑、左氧氟沙星和米诺环素的耐药率低。头孢哌酮-舒巴坦对该菌亦有良好抗菌活性。应根据药敏试验结果合理选用治疗嗜麦芽窄食单胞菌感染的抗菌药物。

CHINET 2010 surveillance of antibiotic resistance in Stenotrophomonas malto-philia in China

Objective To investigate the resistance of clinical Stenotrophomonas maltophilia isolates from 14 hospitals in several regions of China during 2010. Methods Fourteen representative general hospitals were involved in this program. Bacterial susceptibility testing was carried out by means of unified protocol using Kirby-Bauer method and MIC determination. The results were analyzed according to CLSI 2010 breakpoints. Results Most （97.5%） of the 1 661 clinical strains of S. maltophilia were i- solated from inpatients. Only 42 （2. 5 ~ ） isolates were from outpatients. About 68.3 % of the strains were isolated from the elderly patients （〉~60 years of age）. Only 4. 8% of the strains were from patients under 18 years old. Most （83.0%） isolates were from sputum and respiratory tract secretions, followed by blood, abdominal fluid and other sterile body fluids （4. 7 % ）. The percentage of S. maltophilia resistant to sulfamethoxazole-trimethoprim, levofloxacin, minocycline and cefoperazone-sulbactam was 11.2%, 10. 7%, 3.4%, and 13.8%, respectively.About 21.6% and 33.30% of the strains isolated from urine were resistant to trimethoprim-sulfamethoxazole and cefoperazone-sulbac- tam, significantly higher than the isolates from other specimens （P〈0.01）. Conclusions S. maZtophilia was mainly isolated from the sputum of inpatients of 60 years or older. The organism was inherently resistant to most antibacterial agents, but less resistant to sulfa- methoxazole-trimethoprim, levofloxacin and minocycline, the antibiotics recommended by CLSI. Cefoperazone-sulbactam also shows good in vitro activity against these organisms. The surveillance of antimicrobial resistance is very important for guiding rational antimi- crobial therapy, especially for the nosoeomial infections.