奇异变形杆菌耐药性及亚胺培南不敏感株感染的临床特点研究

目的研究奇异变形杆菌的临床分布和耐药情况、亚胺培南不敏感奇异变形杆菌感染的临床特点。方法分析浙江大学医学院附属第一医院2013年1月至2013年12月分离的非重复奇异变形杆菌的药物敏感性、临床分布,回顾性分析亚胺培南不敏感奇异变形杆菌感染患者的临床资料、治疗及预后情况。结果2013年该院共分离107株奇异变形杆菌,以分离自尿液最多,其次为痰液;来源最多的是外科病房和重症监护病房。体外药敏显示：奇异变形杆菌对美罗培南、厄他培南、头孢吡肟、氨曲南、哌拉西林/他唑巴坦、头孢他啶、头孢哌酮/舒巴坦、阿米卡星等抗菌药物敏感性良好,敏感率达85%以上;对亚胺培南敏感率为80.4%;对头孢呋辛、环丙沙星、氨苄西林、头孢曲松、庆大霉素耐药率较高,超过30%;对呋喃妥因耐药率为99%。其中21株亚胺培南不敏感奇异变形杆菌对包括美罗培南、厄他培南在内的其他各类抗菌药物耐药率与亚胺培南敏感株基本相仿。亚胺培南不敏感奇异变形杆菌引起院内获得性感染主要发生在入住ICU、外科术后、广谱抗菌药物使用后、留置各类置管和梗阻性尿路疾病的患者,可引起泌尿系统、皮肤创面、腹腔、血流、生殖道等部位感染,表现为全身炎症反应及局部感染症状。选择敏感抗菌药物治疗后该部分患者预后良好。结论奇异变形杆菌对三、四代头孢菌素,β-内酰胺酶抑制剂合剂等抗生素敏感性良好。亚胺培南不敏感奇异变形杆菌对其他碳青酶烯类抗生素仍保持较高的敏感性。亚胺培南不敏感奇异变形杆菌所引起院内获得性感染主要发生在入住ICU、外科术后、广谱抗菌药物使用后、留置各类置管和梗阻性尿路疾病的患者,预后良好。

Resistance of Proteus mirabilis and clinical features of infection by imipenen non-susceptible strains

Objective To analyze the clinical distribution and antimicrobial resistance of Proteus mirabilis,and learn the clinical features of patients with imipenem-non-susceptible P. mirabilis infection. Methods The antimicrobial sensitivity and clinical distribution of P. mirabilis isolated from January 2013 to December 2013 in our hospital were studied. The relevant clinical data,treatment and prognosis of patients were retrospectively analyzed.Results A total of 107 strains of P. mirabilis were isolated,which were mainly from urine and sputum. Most of the specimens came from surgical wards and then intensive care unit. The susceptibility rate of P. mirabilis to meropenem,ertapenem,cefepime,aztreonam,piperacillin /tazobactam,ceftazidime,cefoperazone /sulbactam,and amikacin were all over 85%. Susceptibility to imipenen was 80. 4%. The resistance rate to cefuroxime,ciprofloxacin,ampicillin,ceftriaxone and gentamycin were all above 30%. And the resistance rate to nitrofurantoin was99%. 21 isolates were non-susceptible to imipenem. The resistance rates of these isolates to other antimicrobial agents including meropenem and ertapenem were similar to those of imipenem susceptible isolates. Imipenem nonsusceptible P. mirabilis usually caused hospital associated infections among the patients in ICU,after surgery,exposed to broad-spectrum antibiotic,indwelled catheters or suffered from urinary tract obstruction disease. Imipenem non-susceptible P. mirabilis could cause infections of urinary tract,wounds of surgery sites,abdominal cavity,bloodstream and gential tract,characterized by systemic inflammation and local infection. Good outcome was seen in patients who received sensitive antimicrobial treatment. Conclusion P. mirabilis are highly sensitive to third and forth generation cephalosporins and β-lactam /β-lactamase inhibitor combinations. Imipenen non-susceptible P.mirabilis strains are also sensitive to other cabapenems,but give rise to hospital acquired infections in patients in ICU,after surgery,with broad-spectrum anti