下呼吸道感染非发酵菌的病原学与耐药性监测研究  

A Retrospective Analysis of Distribution and Antibiotic Resistance Changes of Nonfermenters in Lower Respiratory Tract Infection

作　　者：梅晓冬[1] 蒋旭琴[1] 濮跃晨[2] 杜飞[2] 

机构地区：[1]安徽医科大学附属省立医院呼吸内科,安徽合肥230001 [2]安徽医科大学附属省立医院检验科,安徽合肥230001

出　　处：《中华医院感染学杂志》2009年第17期2328-2331,共4页Chinese Journal of Nosocomiology

摘　　要：目的了解医院内下呼吸道感染常见非发酵菌的分布及耐药性变化情况,为临床合理用药提供依据。方法对医院2003-2007年下呼吸道感染住院患者痰标本所分离的非发酵菌的菌种分布和耐药性资料进行回顾性统计分析。结果非发酵菌排前4位依次是铜绿假单胞菌、鲍氏不动杆菌、鲁氏不动杆菌和嗜麦芽寡养单胞菌;非发酵菌对15种常用抗菌药物的耐药性总体呈上升趋势,5年变化较为明显的是铜绿假单胞菌对头孢他啶的耐药率从2003年的30.2%升至2005年的55.4%,2006年保持在54.8%,2007年回落到41.5%;对庆大霉素的耐药率从2003年的20.8%升至2007年的36.1%;对亚胺培南、奈替米星、替卡西林和妥布霉素的耐药率也上升较明显;鲍氏不动杆菌对亚胺培南耐药率上升最为显著,5年从21.1%升至59.7%,鲁氏不动杆菌耐药率仍较低,嗜麦芽寡养单胞菌对15种常用抗菌药物呈现多药耐药,除对复方新诺明以及头孢他啶、替卡西林耐药率较低外,其余均在61.9%～100.0%。结论非发酵菌是下呼吸道感染主要革兰阴性杆菌,其中以铜绿假单胞菌、鲍氏不动杆菌和嗜麦芽寡养单胞菌最为常见且呈多药耐药,耐药率有上升趋势。OBJECTIVE To investigate the distribution and antibiotic resistance of nonfermenting gram-negative bacilli isolated from lower respiratory tract infection patients from 2003 to 2007 for rational antimicrobial therapy in practice. METHODS The data of distribution and antibiotic resistance of nonfermenting gram-negative bacilli isolated from sputum samples of lower respiratory tract infection in our hospital from 2003 to 2007 were retrospectively analysed. RESULTS The most predominant nonfermenting gram-negative .bacilli isolates were Pseudomonas aeruginosa , Acinetobacter baumannii , Acinetobacter lwo f fii and Stenotrophomonas maltophilia. From 2003 to 2007, the resistance rates of these isolates to 15 antibiotics increased, especially P. aeruginosa to ceftazidime. The resistance changed from 30.2% in 2003 to 55.4% in 2005, 54. 8% in 2006, and reduced to 41.arcillin and tobramycin varied in the similar 5% in 2007. The resistance to gentamicin, imipenem, netilmicin, ticway. The resistance of A. baumannii to imipenem increased from 21.1 % to 59.7% within the five years. The resistance rate of A. lwoffi was still relatively low. S. maltophilis isolates were highly multi-resistant to antimicrobial agents tested with a rate ranging from 61. 9%-100. 0% except ceftazidime, ticarcillin and trimethoprim-sulfamethoxazole. CONCLUSIONS P. aeruginosa, A. baumanii and S. maltophilia are the main nonfermentive pathogens of lower respiratory tract infections and not susceptive to many antibiotics. The tendency of susceptibility and distribution changes of those bacteria should be considered in practice for proper antimicrobial therapy.

关 键 词：下呼吸道感染 非发酵菌 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]