呼吸科和呼吸监护病房非发酵菌耐药性分析

目的研究我院呼吸科和呼吸监护病房(RICU)近5年呼吸道感染及耐药情况。方法收集2001—2005年我院呼吸科和RICU分离出的呼吸道感染病原菌,对其中621株非发酵菌作体外药敏试验,对其结果进行分析比较。结果5年中共分离出革兰阴性杆菌1288株,其中呼吸科907株,RICU381株。非发酵菌621株,占同期分离出的革兰阴性杆菌的48.3%。其中呼吸科306株,占革兰阴性杆菌的33.7%(306/907),铜绿假单胞菌最多见(146株,16.1%),其次为鲍曼不动杆菌(119株,13.1%),嗜麦芽窄食单胞菌(24株,2.6%)和其他(17株,1.9%)。RICU315株,占革兰阴性杆菌的82.7%(315/381),鲍曼不动杆菌最多见(134株,35.2%),其次为铜绿假单胞菌(113株,29.7%),嗜麦芽窄食单胞菌(50株,13.1%)和其他(18株,4.7%)。铜绿假单胞菌对阿米卡星的敏感率最高,为81.3%,对亚胺培南的敏感率较低(48.8%);鲍曼不动杆菌对亚胺培南的敏感率最高,为95.6%,对头孢哌酮-舒巴坦的敏感率仅为40.4%;嗜麦芽窄食单胞菌对头孢哌酮-舒巴坦的敏感率最高,为86.8%,其次为左氧氟沙星(78.9%),头孢他啶(72.7%),对其他抗菌药的敏感率均很低。铜绿假单胞菌和鲍曼不动杆菌的耐药率在呼吸科和RICU有显著差异,而嗜麦芽窄食单胞菌的耐药率在2个病房差异不显著。结论呼吸科中非发酵菌检出率高且耐药性强,在RICU分离菌株的耐药性明显高于普通病房,在应用抗菌药物治疗时应根据药敏结果和流行特点选择用药,避免进一步产生耐药菌。

Antibiotic resistance of nonfermentative gram-negative bacilli in respiratory ward and respiratory intensive care unit

Objective To investigate the prevalence and susceptibility of nonfermentative gram-negative bacilli in our respiratory ward and respiratory intensive care unit (RICU).Methods Nonfermenters were collected from January, 2001 to December, 2005 in respiratory ward and RICU. The bacterial susceptibility testing was performed by agar dilution test.Results A total of 621 nonfermenter strains were collected during the 5-year period, 306 of which were isolated from respiratory ward. The most common pathogen was P. aeruginosa (16.1%), followed by A .baumannii (13.1%) and S. maltophilia (2.6%). The most common pathogens among the 315 strains from RICU were A. baumannii (35.2%), P. aeruginosa (29.7%), and S. maltophilia (13.1%). The most active drug against P. aeruginosa was amikacin (81.3%). The susceptibility rate of P. aeruginosa to imipenem was relatively low (48.8%). About 95.6% of the A. baumannii isolates were susceptible to imipenem, while only 40.4% of the strains were susceptible to cefoperazone-sulbactam. About 86.8%, 78.9% and 72.7% of S. maltophilia isolates were susceptible to cefoperazone-sulbactam, levofloxacin and ceftazidime, respectively. The resistant rate of P. aeruginosa and A. baumannii from respiratory ward and RICU to most antibiotics was significantly different.Conclusions The prevalence of nonfermenters is rather high in respiratory department, especially in RICU. Antimicrobial therapy should be decided according to the results of susceptibility testing.