褪色沙雷菌医院感染现状及耐药性分析  

Current status of prevalence of nosocomial infections caused by Serratia marcescens and analysis of drug resistance

作　　者：方叶青[1] 胡庆丰[2] 魏取好[2] 吕火烊[2] 

机构地区：[1]慈溪市妇幼保健院检验科,浙江慈溪315300 [2]浙江省人民医院检验医学中心,浙江杭州310014

出　　处：《中华医院感染学杂志》2015年第5期1014-1016,共3页Chinese Journal of Nosocomiology

基　　金：浙江省自然科学基金资助项目(Y2110743)

摘　　要：目的了解褪色沙雷菌的临床感染特点及耐药现状,为临床治疗和医院感染控制提供帮助。方法回顾性分析2008-2012年临床分离的300株褪色沙雷菌临床分布及其耐药谱变化,比较ICU与非ICU不同病区之间耐药性差异。结果 5年医院感染褪色沙雷菌的临床分离率逐年递增,从2008年的0.8%上升至2012年的5.3%;其主要分布在ICU、外科、内科、呼吸科,分别占44.7%、17.3%、16.0%、7.7%,标本来源以痰液最多占85.6%;褪色沙雷菌对头孢哌酮/舒巴坦、头孢他啶、头孢曲松、亚胺培南及庆大霉素耐药性呈递增趋势(P<0.05),至2012年该菌对头孢哌酮/舒巴坦的耐药率达24.7%、头孢曲松59.2%、亚胺培南24.3%、庆大霉素24.9%;对阿米卡星、妥布霉素、左氧氟沙星比较敏感,耐药率分别为1.2%、3.6%、5.9%;ICU褪色沙雷菌对复合制剂、头孢菌素及碳青霉烯类的耐药率明显高于非ICU,而对氨基糖苷类及喹诺酮类抗菌药物的敏感性高于非ICU。结论褪色沙雷菌导致的感染呈增高趋势,且耐药率逐年升高,临床应根据药敏试验结果合理选用抗菌药物,防止耐药菌株的产生和医院感染的扩散。OBJECTIVE To understand the clinical characteristics of Serratia marcescens infections and observe the current status of drug resistance so as to provide guidance for clinical treatment and control of nosocomial infections .METHODS From 2008 to 2012 ,the distribution of 300 clinical S .marcescens isolates was retrospective‐ly analyzed ,the change of the drug resistance spectrum was observed ,and the drug resistance of the strains was compared between the ICU wards and the non‐ICU wards .RESULTS During the five years ,the clinical isolation rate of S .marcescens causing nosocomial infections was increased year by year ,increasing from 0 .8% in 2008 to 5 .3% in 2012 .Among the isolated S .marcescens strains ,44 .7% were isolated from the ICU1 ,17 .3% from the surgery department ,16 .0% from the internal medicine department ,7 .7% from the respiratory department ;the sputum was the predominant specimen source ,accounting for 85 .6% .The drug resistance of the S .marcescens to cefoperazone‐sulbactam ,ceftazidime , ceftriaxone , imipenem , and gentamycin showed an upward trend （ P〈0 .05）;by 2012 ,the drug resistance rate to cefoperazone‐sulbactam reached 24 .7% ,ceftriaxone 59 .2% ,imipen‐em 24 .3% ,gentamycin 24 .9% ;the S .marcescens strains were highly susceptible to amikacin ,tobramycin ,and levofloxacin ,with the drug resistance rates of 1 .2% ,3 .6% ,and 5 .9% ,respectively ;the drug resistance rates of the S .marcescens strains isolated from the ICUs to compound preparation ,cephalosporins ,and carbapenems were significantly higher than those of the strains isolated from the non‐ICUs ,while the drug susceptibility rate to ami‐noglycosides and quinolones were higher in the ICUs than in the non‐ICUs .CONCLUSION The incidence of the S . marcescens infections shows an upward trend .It is necessary for the hospital to reasonably use antibiotics on the basis of the results of drug susceptibility testing so as to prevent the emergence of drug‐resistant strains and the dissemination of nosocomia

关 键 词：褪色沙雷菌 耐药性 重症监护病房 

分 类 号：R378[医药卫生—病原生物学]