三甲医院非发酵菌的临床分布和耐药对比研究  

A Comparative Study on Clinical Distribution and Drug Resistance of Non-fermentative Bacilli from Large Comprehensive Class A Hospitals

作　　者：郭海燕[1] 陈惠玲[2] 韩福郎[3] 梁志科[4] 丘新才[1] 

机构地区：[1]南方医科大学附属南海医院呼吸内科,广东佛山528200 [2]广州医科大学附属广州市第一人民医院细菌实验室,广州510180 [3]南方医科大学附属南海医院细菌实验室,广东佛山528200 [4]广州医科大学附属广州市第一人民医院呼吸内科,广州510180

出　　处：《临床误诊误治》2016年第6期77-80,共4页Clinical Misdiagnosis & Mistherapy

基　　金：广东省自然科学基金项目(2015A030313728);佛山市卫生和计生局医学科研课题(2015021)

摘　　要：目的对比三甲综合医院非发酵菌的临床分布特点及耐药性,为临床诊治非发酵菌感染及政府制定卫生方针提供依据。方法回顾性收集2013年1月—2015年9月广东省两所三甲医院（A医院、B医院）检出非发酵菌送检标本,对常见的非发酵菌临床分布、组成和耐药性进行对比分析。结果近3年两所三甲医院标本来源第一位均为痰,铜绿假单胞菌来源第一位科室均为呼吸科,鲍曼不动杆菌、嗜麦芽窄食单胞菌、洋葱伯克霍尔德菌均来源于重症监护病房;分离细菌各11 610、6 889株,A医院较B医院的常见非发酵菌检出率高（22.0%vs 16.4%,P〈0.01）;铜绿假单胞菌均对第三、四代头孢菌素类及氨基糖苷类、第三代喹诺酮类、亚胺培南耐药率低（≤26%）,但A医院亚胺培南耐药率是B医院的两倍（26%vs 13%,P〈0.01）;鲍曼不动杆菌耐药率均较高（≥44%）,A医院与B医院比较,除对阿米卡星耐药率低（7%vs 45%,P〈0.01）、嗜麦芽窄食单胞菌对第三代喹诺酮类耐药率低（15%-31%）外,余耐药率均较高（≥77%）。对第三、四代头孢菌素类及左氧氟沙星、亚胺培南耐药率洋葱伯克霍尔德菌A医院耐药率高（≥71%）,而B医院低（≤26%）。结论近年我区三甲综合医院分离的铜绿假单胞菌耐药率较低,鲍曼不动杆菌、嗜麦芽窄食单胞菌耐药率高,应加强各级医院院内非发酵菌耐药性监测,制定合理的临床用药策略。Objective To compare the characteristics of clinical distribution and drug resistance of non-fermentative bacilli from large comprehensive Class A hospitals,so as to provide guidance for the clinical diagnosis and treatment of nonfermentative bacilli as well as for the government to develop health policy. Methods Bacteria identification was performed for a variety of specimens which were retrospectively collected in large comprehensive Class A hospitals in Guangdong Province from January 2013 to September 2015,and then the clinical distribution,constituents,and drug resistance of the common non-fermentative bacilli were analyzed. Results In nearly three years,sputum ranked the first as specimens in these two large provincial hospitals. The department of respiratory diseases ranked the first as the source of Pseudomonas aeruginosa,while Intensive Care Unit was the source of Acinetobacter baumannii,Stenotrophomonas maltophilia,and Burkholderia Cepacia. A total of 11 610,6889 strains of pathogens were isolated respectively. Class A hospitals showed higher isolated rate than Class B hospitals（ 22. 0% vs 16. 4%,P〈0. 01）. Pseudomonas aeruginosa from the two hospitals were both found to have low resistance rates to the third and fourth generations of the cephalosporins,amino glycosides,the third-generation of quinolones,and imipenem（ ≤26%）. However,resistance rates to imipenem in Class A hospitals were twice that of Class B hospitals（ 26% vs 13%,P〈0. 01）. Acinetobacter baumannii showed relatively high drug resistance rates in the two hospitals（ ≥44%）,Compared with these two hospitals,except that there were lower resistance rates to amikacin in Class A hospitals than in Class B hospitals（ 7% vs 45%,P〈0. 01）,Stenotrophomonas maltophilia were found to had low resistance rates to the third-generation of quinolones（ 15% - 31%）,and others had high resistance rates（ ≥77%）. Burkholderia Cepacia showed high resistance rates to the third-and fourth-generations of the cephalosporins,levoflox

关 键 词：非发酵菌 医院 综合 耐药性 对比研究 

分 类 号：R446.5[医药卫生—诊断学]