不发酵糖革兰阴性杆菌的分布和耐药性分析

目的了解北京安贞医院2008--2012年不发酵糖革兰阴性杆菌的临床分布和耐药情况。方法采用VITEK—compact系统和Phoenix 100系统进行细菌鉴定，稀释法进行体外抗菌药物敏感试验。结果临床分离不发酵糖革兰阴性杆菌2450株。其中鲍曼不动杆菌1401株（57．2％），铜绿假单胞菌625株（25．5％），嗜麦芽窄食单胞菌246株（10．0％）。标本来源依次为呼吸道（80．9％）、血液（8．1%）和伤口分泌物（3．9%）。科室分布依次为重症监护室（50．0％）、心脏外科（17．0%）和呼吸内科（11．5%）。药敏试验结果显示，2008--2012年鲍曼不动杆菌对亚胺培南的耐药率分别为62．3％、79．2％、70．4％、76．1％和67．8％；铜绿假单胞菌对亚胺培南的耐药率分别为28．7％、25．0％、27．6％、31．1％和32．0％；嗜麦芽窄食单胞菌对甲氧苄啶-磺胺甲口恶唑和左氧氟沙星敏感率最高。结论由于不发酵糖革兰阴性杆菌有较高的耐药性，治疗时应根据药敏试验结果合理选用抗菌药物。

Distribution and antibiotic resistance profile of nonfermentative gram negative bacteria

Objective To investigate the clinical distribution and antibiotic resistance of the nonfermenting bacterial strains isolated in Beijing Anzhen Hospital from 2008 to 2012. Methods The bacteria were identified by VITEK-compact system and Phoenix 100 system. Antimicrobial susceptibiity was tested by dilution method. Results A total of 2 450 strains of nonfermentative gram-negative bacteria were isolated from clinical specimens. Acinetobacter baumannii, Pseudomonas aeruginosa and Stenotrophomonas rnaltophilia accounted for 57. 2%, 25.5% and 10.0%. Specimens were mostly collected from respiratory tract （80.9%）, followed by blood （8.1%） and wound exudates （3.9%）. The strains were mainly collectd from ICU （50.0%）, cardiac surgery ward （17.0%） and respiratory medical ward （11.5%）. The prevalence of imipenem- resistant A. baumannii was 62. 3%, 79. 2%, 70. 4%, 76. 1%, 67. 8% from 2008 to 2012. The prevalence of imipenem- resistant P. aeruginosa was 28. 7%, 25.0%, 27. 6%, 31. 1% and 32. 0%. S. rnaltophilia strains showed the highest susceptibility to trimethoprim-sulfamethoxazole and levofloxacin. Conclusions The high prevalence of antibiotic-resistant nonfermenting bacteria poses a great challenge to clinicins, The rational treatment choice should be based on the result of suseptibility testing.