下呼吸道非发酵菌感染特征与药物敏感性分析 FREE

目的分析某院下呼吸道感染非发酵菌的细菌分布及药敏情况。方法对2006年1月-2008年12月发生下呼吸道非发酵菌感染的648例病例资料进行统计分析。结果分离率居前4位的非发酵菌分别为铜绿假单胞菌(277株,42.75%)、鲍曼不动杆菌(158株，24.38%)、嗜麦芽窄食单胞菌(59株，9.10%)、洋葱伯克霍尔德菌(47株，7.25%)。临床分布以患者平均年龄较大的地方干部病房（261株，40.28%)和军队高干病房（120株，18.52%)为主，此外是呼吸内科(111株，17.13%)、重症监护室(96株，14.81%)等。在几种主要致病菌中，铜绿假单胞菌对阿米卡星和亚胺培南等敏感性较高；鲍曼不动杆菌对亚胺培南、环丙沙星、阿米卡星以及含β 胺酶抑制剂的抗菌药物敏感；嗜麦芽窄食单胞菌对多数抗菌药高度耐药，仅对复方磺胺甲口恶唑较为敏感；洋葱伯克霍尔德菌耐药率较高，对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦等表现出一定敏感性。结论非发酵菌为医院下呼吸道感染的重要致病菌，且大部分耐药较为严重；不同菌种对抗菌药物的敏感性有较大差异，临床治疗应根据药敏结果及该菌耐药机制合理用药。

Characteristics and drug sensitivity of non fermentative bacteria in lower respiratory tract infection FREE

Objective To analyze the distribution and drug sensitivity of non-fermentative bacteria in lower respiratory tract infection. Methods Sixty hundred and forty-eight cases with non-fermentative bacterial lower respiratory tract infection between January , 2006 and December , 2008 were analysed. Results The first four isolated non-fermentative bacteria were Pseudomonasaeruginosa （277 strains, 42. 75%）, Acinetobacterbaumannii （158 strains, 24. 38%）, Stenotrophomonas maltophilia （59 strains,9. 10%） and Burkholderia cepacia （47 strains, 7. 25%）. Infection cases mainly distributed in local officials wards （261 strains, 40. 28%） and military cadres wards （120 strains, 18. 52 %） with the older average age of patients, department of respiratory medicine （ 111 strains, 17. 13 %） and intensive care unit （96 strains, 14. 81% ） also had a higher isolation rates. Pseudomonas aeruginosa was sensitive to amikacin and imipenem ; Acinetobacter baumannii was sensitive to imipenem, ciprofloxacin, amikacin and antimicrobial agents with β-lactamas inhibitors ; Stenotrophomonas maltophilia was strongly resistant to multiple antimicrobial agents , but sensitive to sulfamethoxazole/trimethoprim only. Burkholderia cepacia had higher drugresistant rate, but was sensitive to piperacillin/tazobactam and cefoperazone/sulbactam. Conclusion Nonfermentative bacteria are important pathogen in nosocomial lower respiratory tract infection, and most of them are serious drug resistant, drug sensitivity varies with different types of strains, clinical treatment should be based on antimicrobial susceptibility tests and mechanisms of drug resistance.