嗜麦芽寡养单胞菌临床分布特征与耐药分析

目的了解湖州市中心医院嗜麦芽寡养单胞菌临床分布特征与耐药性。方法采用常规方法分离，用VITE-COMPACT2全自动微生物分析仪进行菌种鉴定，用K—B法进行药敏试验。结果分离到嗜麦芽寡养单胞菌810株，复方新诺明耐药菌株48株（分离率5．9％）。标本来源主要来自ICU室，其次呼吸科，大部分来自痰液标本（约占89．2％），年龄段以中老年人比率最高。嗜麦芽寡养单胞菌对亚胺培南、美罗培南、头孢吡肟、哌拉西彬他坐巴坦、庆大霉素、妥布霉素、阿米卡星高度耐药；头孢他啶、替卡西林／克拉维酸、环丙沙星耐药率为33．7％～58．2％；头孢哌酮／舒巴坦、左氧氟沙星、米诺环素、复方新诺明耐药率低于30．0％。复方新诺明耐药菌株对头孢哌酮／舒巴坦、左氧氟沙星和米诺环素耐药率分别为60．4％、91．7％和2．0％，对其余抗菌药物耐药率达100．0％。复方新诺明耐药菌株与复方新诺明敏感菌株相比，耐药情况更严重，其中对三、四代头孢菌素、喹诺酮类耐药率显著高于复方新诺明敏感菌株（P〈0．01）；对碳青霉烯类、青霉素类、氨基糖苷类抗菌药物耐药率与复方新诺明敏感菌株相比，差异无统计学意义（P〉0．05）。结论嗜麦芽寡养单胞菌呈高度耐药，对头孢哌酮／舒巴坦、左氧氟沙星、米诺环素、复方新诺明尚敏感，但对复方新诺明耐药的嗜麦芽寡养单胞菌耐药现象更严重。应重视嗜麦芽寡养单胞菌引起的院内感染，尽量减少不必要的侵人性操作，加强抗菌药物的合理规范使用。

Stenotrophomonas maltophilia clinical distribution and drug resistance analysis

Objective To understand the clinical distribution and drug resistance of Stenotrophomonas maltophilia in Huzhou Central Hospital.Methods The conventional method,VITE-COMPACT2 automatic microorganism analyzer for strain identification,K-B method for antifungal susceptibility testing were used.Results 810 strains of Stenotrophomonas maltophilia were isolated,as well as 48 cotrimoxazole resistant strains(separation rate 5.9%).Specimens were mainly from ICU,followed by respiratory department,most of them being sputum specimens(about 89.2%) and from elderly people.The Stenotrophomonas maltophilia isolated was highly resistant to imipenem,meropenem,cefepime,piperacillin/tazobactam,gentamicin,tobramycin and Amikacin;Its resistance rates to ceftazidime,ticarcillin/clavulanate and ciprofloxacin resistance rate were between 33.7% and 58.2%,while those to cefoperazone/sulbactam,levofloxacin,,minocycline and cotrimoxazole were less than 30%.The resistance rates of cotrimoxazole resistant strains to cefoperazone/sulbactam,levofloxacin and minocycline were 60.4%,91.7% and 2%,respectively,and 100% to all the other antimicrobial drugs.Their resistance rates to the 3rd or 4th generation cephalosporins and quinolones were significantly higher than that of cotrimoxazole sensitive strains(P<0.01);As to carbapenems,penicillin and aminoglycosides,the resistance rates showed no significant difference from the cotrimoxazole sensitive strains(P>0.05).Conclusion Stenotrophomonas maltophilia is highly resistant,although relatively sensitive to cefoperazone/sulbactam,levofloxacin,minocycline and cotrimoxazole,while the resistance of its cotrimoxazole-resistant strains is more serious.Attention should be paid to nosocomial infections caused by it;Unnecessary invasive procedures should be minimized;Reasonable use of antibiotics should be strengthened.