医院非发酵菌感染及耐药性分析

目的 探讨引起医院感染的非发酵菌分布及其对常用抗菌药的耐药情况。方法 临床标本中分离的347株非发酵菌对常用抗菌药物的敏感性及其临床感染分布作回顾性分析。结果 非发酵菌占临床总细菌分离率的23．6％，347株非发酵菌中铜绿假单胞菌最多(63．1％)，其次为鲍曼不动杆菌和嗜麦芽窄食单胞菌，分别为11．2％和10.1％，其它非发酵菌相对较少。分布部位以下呼吸道分离率最高(70．6％)，其次为创面分泌物和泌尿道，分别为13．7％、8．9％。非发酵菌对阿莫西林、庆大霉素、第一、二代头孢菌素、喹诺酮类等多种抗菌药物耐药(53．0％～90．9％)，而对哌拉西林、亚胺培南(嗜麦芽窄食单胞菌除外)、阿米卡星耐药率较低(7．7％～28．6％)，加酶抑制剂抗菌药物对医院常见非发酵菌的耐药率明显低于不含酶抑制剂抗菌药物。结论 临床分离菌中非发酵菌日益增多，对抗菌药物呈多重耐药，应在医院开展细菌耐药性监测，指导临床合理应用抗菌药物。

Non-fermentive bacterial infection and antibiotic resistance in hospital

Objective To observe the distribution of non-fermentive bacteria in hospital and analyze their antibiotic resistance.Methods The data of distribution and antibiotic resistance in 347 strains of non-fermentive bacteria isolated from clinical samples between January 2000 and June 2003 were retrospectively analyzed.Results Non-fermentative bacteria accounted for 23.6% of total bacteria isolated from clinical settings. In the 347 strains of non-fermentative bacteria, 63.1% belonged to Pseudomonas aeruginosa, 11.2% Acinetobacter baumannii, and 10.1% Stenotrophomonas maltophilia. The local distribution of the strains was as follows: respiratory tract (70.6%), wound surface secretion (13.7%), urinary tract (8.9%). The resistance rates in all strains against amoxycillin, gentamicin, the first and second generation cephalosporins, and fluoroqunolones were from 53.0% to 90.9%; while the rates in piperacillin, imipenem (excluding Stenotrophomonas maltophilia), and amikacin were lower (7.7% to 28.6%). If antibiotics combining with beta-lactamase inhibitors were given, the resistance was significantly lower than those without combining with beta-lactamase ones.Conclusion The number of non-fermentive bacteria among clinical bacteria has been increasing. There is an urgent need for surveillance of bacteria resistance in different hospitals and rational use of antimicrobial agents during clinical therapy.