引发下呼吸道感染的非发酵菌的菌群分布及耐药性分析

目的了解引发下呼吸道感染的非发酵菌的菌群分布及耐药性分析，为临床合理使用抗生素提供依据。方法对2011年1月至2013年9月深圳罗岗医院门诊及住院患者痰标本分离的非发酵菌的菌群分布及优势菌的耐药性进行回顾性分析。结果702株非发酵菌中铜绿假单胞菌（PA）362株，占51．6％，鲍氏不动杆菌（AB）158株，占22．5％；PA对NIT、CXM、SAM、AMP、CZO、CTF、CRO、SXT耐药率均在99．0％以上，对IPM、LVF和TZP耐药率均在15．0％以下；AB对NIT、CXM、AMP、CZO、CTT耐药率均为100％，对SAM、FEP、TOB、GEN、IPM、LVF和TZP耐药率均在15．0％以下；耐IPM的PA和AB的检出率分别为20．4％和11．4％；耐IPM的PA对NIT、CXM、SAM、AMP、CZO、CTT、CRO、SXT、1PM耐药率均为100％，对其余10种抗生素的耐药率在25．0％～84．0％；耐IPM的AB对NIT、CXM、AMP、CZO、CTT、CRO、SXT、ATM、PIP、IPM耐药率均为100％，对其余9种抗生素的耐药率在21．0％～90．0％。结论引发下呼吸道感染的非发酵菌以PA和AB为主且耐药现象严重，临床医师在选择抗菌药物前应重视病原学培养，根据药敏试验选择用药。

The distribution and drug resistance of non-fermenting bacteria causing lower respiratory tract infection

Objective To learn the distribution and drug resistance of non-fermenting bacteria causing lower respir- atory tract infection, and provide basis for clinical rational use of antibiotics. Methods The bacterial distribution and drug resistance of dominant bacteria isolated from the sputum specimens of out- and in-patients in our hospital from January 2011 to September 2013 were retrospectively analysed. Results Among the total 702 strains of non- fermenting bacteria, there were Pseudomonas aeruginosa （PA） 362 strains （51.6% ） and Acinetobacter baumannii （AB） 158 strains （22.5%）. The resistance rates of PA to NIT, CXM, SAM, AMP, CZO, CqT, CRO, SXT were higher than 99.0% while those to IPM, LVF and TZP were below 15.0%. The resistance rates of AB to NIT, CXM, AMP, CZO, CTT were 100% while those to AM, FEP, TOB, GEN, IPM, LVF and TZP were below 15.0%. The detection rates of IPM-resistant PA and AB were 20.4% and 11.4% respectively. The resistance rates of IPM-resistant PA to NIT, CXM, AMP, CZO, CTT, CRO, SXT, ATM, PIP and IPM were 100% , and those to the other 9 antibiotics were between 25% and 84%. The resistance rates of IPM-resistant AB to NIT, CXM, AMP, CZO, CTT, CRO,SXT, ATM, PIP and PM were 100% , and those to the other 9 antibiotics were between 21.0% and 90.0%. Condusion PA and AB are predominant non-fermenting bacteria causing lower re- spiratory tract infections, and their drug resistance is high. The clinicians should pay much attention to etiology culture before the antibiotics are prescribed.