重症监护病房非发酵菌感染分布特点及耐药情况分析

目的:分析我院重症监护病房(ICU)非发酵菌感染分布及其耐药情况.方法:选取2009年1月～2011年12月我院重症监护病房(ICU)患者,回顾性分析各类临床标本分离的非发酵菌株作体外药敏试验结果.药敏试验采用MIC法及K-B法,按CLSI2010年版判断标准.结果:共分离非发酵菌447株.其中前四位的分别是鲍曼不动杆菌207株(46.31％)、铜绿假单胞菌144株(32.21％)、嗜麦芽窄食单胞菌49株(10.96％)、伯克霍尔德氏菌36株(8.05％).鲍曼不动杆菌仅对头孢哌酮/舒巴坦耐药率较低,为1.55％,对亚胺培南、美洛培南耐药率分别为49.61％、53.48％.铜绿假单胞菌对亚胺培南、美洛培南、阿米卡星及头孢哌酮/舒巴坦耐药率较低,分别为25.95％、29.01％、35.11％及0.76％,嗜麦芽窄食单胞菌及伯克霍尔德氏菌对多种抗菌药物天然耐药,对复方新诺明,喹诺酮类药物耐药率较低.推荐临床治疗使用.结论:非发酵菌是重症监护病房感染常见病原菌,对常用抗菌药物耐药情况严重.应加强耐药性监测,为临床合理应用抗生素,防止院内感染提供依据.

Distribution and antimicrobial resistance of non-fermenters isolated from intensive care unit

Objective: To analyze the characteristics of infection distribution and antimicrobial resistance of non-fermenters isolated from intensive care unit(ICU) at the second hospital of Anhui Medical University.Methods: Non-fermenters were separated and identified from the ICU patients that were admitted to the Second Hospital of Anhui Medical University from January 2009 to December 2011.The antimicrobial susceptibility testing(AST) of non-fermenters was determined by K-B disk diffusion method and minimal inhibitory concentration(MIC) test,respectively.The AST was performed as recommended by CLSI 2010.Results:A total of 447 strains of non-fermenters were isolated from clinical specimens.The four top identified microorganisms were Acinetobacter baumannii(207,46.31%),Pseudomonas aeruginosa(144,32.21%),Stenotrophomonas maltophilia(49,10.96%) and Burkholderia(36,8.05%).The resistance rate of Acinetobacter baumannii to cefoperazone/sulbactam was 1.55% while its resistance to Imipenem and Meropenem significantly increased to 49.61% and 53.48 %,respectively.Resistance of Pseudomonas aeruginosa to Imipenem,Meropenem,Amikacin,and Cefoperazone/sulbactam were 25.95%,29.01%,35.11% and 0.76%,respectively.In contrast to the low resistance rates to sulfamethoxazole and quinolones,Stenotrophomonas maltophilia and Burkholderia had natural resistance to multiple antimicrobial drugs.Conclusions:As prevalent pathogenic agents in ICU,non-fermenters have considerable resistance to commonly used antibiotics.Thus,periodic surveillance is essential for the rational use of antibiotics and the effective prevention of nosocomial infections.