重症监护病房患者感染的非发酵革兰阴性杆菌耐药趋势分析  

Trend analysis of drug resistance of non-fermentative gram-negative bacteria in intensive care unit patients

作　　者：张虎[1] 王照峰[2] 吴镝[1] 刘芳[1] 马文杰[1] 焦力群[1] 曹晋桂[1] 

机构地区：[1]空军总医院感染控制科,北京100142 [2]空军总医院临床检验中心,北京100142

出　　处：《国际检验医学杂志》2014年第3期304-306,共3页International Journal of Laboratory Medicine

摘　　要：目的了解重症监护病房(ICU)分离的非发酵革兰阴性杆菌的分布和耐药谱的变化趋势,为临床合理使用抗菌药物提供依据。方法从该院ICU住院患者的可能感染部位收集标本进行细菌分离培养,培养出的非发酵革兰阴性杆菌采用纸片扩散法进行药敏试验,参照临床实验室标准化委员会(CLSI)制定的标准进行结果判读,用WHONET5.6软件进行统计分析。结果 5年共分离出非发酵革兰阴性杆菌624株,占革兰阴性杆菌的72.8%(624/857);非发酵革兰阴性杆菌中铜绿假单胞菌占43.4%(271/624),鲍曼不动杆菌占42.6%(266/624),嗜麦芽窄食单胞菌占6.4%(40/624),洋葱伯克霍尔德菌占3.3%(21/624);鲍曼不动杆菌对其耐药率较低的抗菌药物包括米诺环素(31.2%)、头孢哌酮/舒巴坦(48.1%)、阿米卡星(64.8%);铜绿假单胞菌对其耐药率较低的抗菌药物包括头孢哌酮/舒巴坦(23.5%)、阿米卡星(26.6%)、哌拉西林/他唑巴坦(31.8%)、嗜麦芽窄食单胞菌;洋葱伯克霍尔德菌对临床实验室标准化协会(CLSI)推荐的抗菌药物敏感率在80%以上。鲍曼不动杆菌耐药率逐年上升,其对碳青霉烯类抗菌药物的耐药率在2009年前低于11%,2010年以后达到80%以上;铜绿假单胞菌的耐药率有逐年下降的趋势,其对碳青霉烯类抗菌药物的耐药率在2008年高于80%,在2012年低于34%。结论非发酵革兰阴性杆菌发生多重耐药的情况严重,医院应重视耐药监测以及抗菌药物的合理应用。Objective To investigate the distribution of the resistance of non-fermenting gram negative bacteria from Intensive care unit（ICU） patients so as to provide the basis for the clinical use of antibiotics. Methods Samples of possible infection site of ICU patients were collected, from which bacteria were isolated. Then the non fermenting gram-negative bacteria were tested for its drug resistance by using Disc diffusion method. All the data were analyzed by WHONET5.6 software according to the breakpoints of CI.SI 2010. Results A total of 624 strains of non-fermenting gram negative bacteria were collected,which accounted for 72.8% （624/857） in gram-negative bacteria. In non fermenting gram-negative bacteria, P. aeruginosa ,A. baumannii, S. maltophilia and B. eepacia accounted for 43.4%（271/624）,42.6% （266/624）,6.4% （40/624） and 3.3% （21%624）,respectively. The most effective antibacterial agents against A. baumannii were minocycline （ 31.2 % ）, cefoperazone/sulbactam（ 48.1% ） and amikacin （ 64.8 % ） ; the most effective antibacterial agents against P. aeruginosa were as follows,cefoperazone/sulbactam（ 23.5 % ）,amikacin（26.6%）, and piperacillin/tazobactam（31.8 % ）. Susceptibility rates of S. maltophilia to trimethoprim/sulfamethoxazole, minocycline and Ievoflox acin were 80 % or above. The resistance rate of A. baumannii increased with years, before 2009 the resistance rates to carbarpenem was less than 11%, which has increased to be over 80% since 2010. The resistance rates of P. aeruginosa to imipenem had de- creased,the resistance rate to earbarpenem decreased from higher than 80% in 2008 to less than 34% in 2012. Conclusion Multi- drug resistance of non-fermenting gram-negative bacteria is a severe problem in hospital,medical staff should pay more attention to resistance monitoring and the rational use of antibiotics.

关 键 词：非发酵革兰阴性杆菌 重症监护病房 细菌耐药性 

分 类 号：R446.5[医药卫生—诊断学]