医院感染非发酵菌的临床分布与耐药监测  

The clinical distribution and resistance surveillance of non-fermenting bacteria

作　　者：马均宝[1] 黄子华 

机构地区：[1]广东省佛山市第一人民医院检验科,528000 [2]广东省佛山市禅城区中心医院检验科,528000

出　　处：《检验医学与临床》2014年第A02期185-187,共3页Laboratory Medicine and Clinic

摘　　要：目的对佛山地区2010～2011年医院感染非发酵菌的临床分布特点及其耐药状况进行监测和分析，为临床合理使用抗菌药物探寻最佳方法。方法各种临床送检标本按常规分离培养，使用法国梅里埃公司Vitek2-compact全自动微生物分析仪，结合半自动ATB微生物检测仪与K-B药敏纸片法相结合进行鉴定和药敏试验，并执行美国国家临床实验标准化研究所（CLSI）2009年规定的标准进行药敏试验的折点判断。结果共分离出4809株非发酵革兰阴性杆菌，检出率以铜绿假单胞最高（1458株，30.0％），其次为鲍曼不动杆菌（730株，15.2％）、嗜麦芽窄食单胞菌（412株，8.6％）和洋葱伯克霍尔德菌（346株，7.2％）。药敏显示，各种非发酵菌对临床常用的各类抗生素均出现不同程度的耐药性，以氨苄西林／舒巴坦和、头孢唑啉、头孢呋辛和头孢西丁为甚，其耐药率可高达96.4％、99.6％、99.1％和98.6％；第3、4代头孢类和氨曲南等的耐药率虽比前者为低，但也出现不同程度的耐药，最高达80％；碳青霉烯类和阿米卡星、舒普深、左氧氟沙星等仍是活性较高的抗菌药物。结论非发酵菌已成为医院感染的最主要病原菌，对各类抗生素都显示不同程度的耐药性，且其耐药率多呈上升趋势，临床应充分利用微生物实验室提供的监测数据，选择最佳的用药方案。Objective Monitor and analysis the distribution and resistance of non-fermentative bacteria from2010 to 2011 in Foshan region,to find a reasonable method of clinical application. Methods All kinds of clinical sam- ples were operated according to the conventional cultivation , Strain identification and drug susceptibility were ana- lyzed with the French Merieux Vitek2-compact automated microbial analyzer, combined with semi-automatic ATB mi- crobial analyzer and K-B test. Fold point judgement of drug sensitive test was employed accordance with American National Standards Institute clinical trials（CLSI）-2009 standards. Results 4809 strains non-fermentative gram-nega- tive bacteria were isolated. The detection rate of P. aeruginosa was the highest（1 458,30.0%）,followed by Acineto- bacter baumannii（730,15.2%）, Stenotrophomonas maltophilia（412,8.6%） and onion fake Single-cell bacteria （ 346, 7.2%）. Susceptibility test results showed that all kinds of non-fermentation strains appeared different levels of resist- ance to all kinds of antibiotics . The rate of resistance with ampicillin/sulbactam, cefazolin, cefuroxime and cefoxitin could be as high as 96.4% ,99.6% ,99.1% and 98.6%. The rate of resistance with the third and fourth generations cephalosporins and aztreonam was lower than those before, but strain also appeared varying degrees in drug resist- ance, which can reach 80%. Carbapenems and amikacin, Sulperazon, levofloxacin, etc. are still active high Antibiotics. Conclusion The non-fermentation bacteria came from varying ways, which Various types of antibiotics have shown varying degrees of drug resistance. Doctor should make full use of microbiology laboratory data to select the most rea- sonable regimen for treatment.

关 键 词：非发酵菌 耐药性 抗菌药物 监测分析 

分 类 号：R181.34[医药卫生—流行病学]