重症监护病房非发酵菌的分布与耐药性分析

目的　了解重症监护病房（ ICU）患者非发酵菌的分布和耐药情况,给临床使用抗菌药物提供参考。方法　对浙江省温州医学院附属第二医院2007 年7 月至2008年9月ICU 感染患者细菌培养和药敏试验的结果进行回顾性分析和统计。结果　在4109 例标本中, 共分离出非发酵菌952 株，居前4位的非发酵菌分别是:洋葱伯克霍尔德菌243株（占25.5%），铜绿假单胞菌200株（占21.0%），鲍曼不动杆菌163株（占17.1%），嗜麦芽窄食单胞菌148株（占15.6%）。药敏结果显示:洋葱伯克霍尔德菌对派拉西林/他唑巴坦和复方新诺明的耐药率最低，分别为2.5%和9.5%；铜绿假单胞菌对各种抗菌药物的耐药率均大于20.0%，以对阿米卡星的耐药率（22.0%）为最低，对其他各种抗菌药物的耐药率在32.0%～95.0%之间；鲍曼不动杆菌对各种抗菌药物的耐药率均大于50%,许多菌株呈多重耐药；嗜麦芽窄食单胞菌对复方新诺明的耐药率最低,为4.1%，对除头孢他啶外的三、四代头孢菌素、氨基糖苷类、氨苄西林/舒巴坦和氨曲南的耐药率在79.7%～95.9 %之间,对亚胺培南天然耐药。结论　洋葱伯克霍尔德菌、铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌是引起医院ICU感染的主要非发酵菌,对多种抗菌药物存在高耐药率,临床应引起高度重视并加强耐药性监测,根据药敏试验结果合理选用抗菌药物，以减少耐药菌株的产生。

Distribution and drug resistance of nonfermenters in intensive care units

Objective To determine the distribution and drug resistance of nonfermenters in intensive care units （ICU）, providing evidence for the clinical administration of antibacterial drugs. Methods Retrospective and statistical analysis was performed based on the results of bacterial culture and sensitivity test for infected patients in ICU from July 2007 to September 2008. Results A total of 952 isolates of nonfermenters were identified out of 4109 samples. The top four predominant strains were Burkholderia cepacia （243, 25.5% ）, Pseudomonas aeruginosa （200, 21.0% ）, Acinetobacter baumannii （163, 17.1% ）, and Stenotrophmonas maltophilia （148, 15.6% ）. The sensitivity test results showed that Burkholderia cepacia possessed the lowest resistance to piperacillin/tazobaetam and cotrimoxazole as 2.5% and 9.5%; Pseudomonas aeruginosa had over 20% resistance to a variety of antibiotics, the minimum rate being 22.0% to amikaein and the resistance to other anti- bacterial drugs ranging from 32.0% to 95.0%; Acinetobacter baumannii was over 50% resistant to various antibiotics and most strains presented multi-drug resistance; maltophilia had the slightest resistance to cotrimoxazole, 4.1%, with the resistance to other antibiotics such as the third- and fourth-generation cephalosporins, aminoglycosides and ampicillin / sulbaetam and aztreonam, except for ceftazidime, ranging from 79.7% to 95.9%. Besides, it possessed the natural resistance to imipenem. Conclusion Burkholderia cepacia, Pseudomonas aeruginosa, Acinetobacter baumannii, and Stenotrophmonas maltophilia constituted the major non- fermenting bacteria to cause infections in ICUs. Given their high resistance to a series of antibiotics, great importance should be attached to the resistance surveillance and proper administration in accordance with the sensitivity test results in order to minimize drugresistant strains.