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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 clinical distribution characteristics and drug resistance of non-fermentative bacteria in the KCRC and provide the basis for clinical diagnosis and treatment of non-fermentative bacteria infection and government’s development of health guidelines. Methods Retrospectively collected from January 2013 to September 2015, two top three hospitals in Guangdong Province (A Hospital, B Hospital) were detected non-fermentative bacteria specimens, the common non-fermentative bacteria clinical distribution, composition and resistance Comparative analysis. Results The first three specimens of the two top three hospitals were sputum in the past three years. The first department of Pseudomonas aeruginosa was respiratory department, Acinetobacter baumannii, Stenotrophomonas maltophilia, The bacteria were all from ICU, 11 610 and 6 889 bacteria were isolated respectively. The detection rate of common non-fermentative bacteria in hospital A was higher than that in hospital B (22.0% vs 16.4%, P <0.01) All the strains were resistant to the third and fourth generation cephalosporins and aminoglycosides, the third generation of quinolones and imipenem (≤26%), but the resistance rate of imipenem in hospital A was B hospital (26% vs 13%, P <0.01). Acinetobacter baumannii resistant rate was higher (≥44%). Compared with hospital B, 7% vs 45%, P <0.01). The drug resistance rate of Stenotrophomonas maltophilia was higher (≥77%) than that of the third generation quinolones (15% ~ 31%). The third and fourth generation cephalosporins and levofloxacin, imipenem resistant Burkholderia cepacium A hospital high resistance rate (≥ 71%), while the B hospital low (≤ 26%). Conclusions In recent years, the resistance rate of Pseudomonas aeruginosa isolated in the Third A General Hospital in our district is relatively low. The rates of drug resistance of Acinetobacter baumannii and Stenotrophomonas maltophilia are high, and the non-fermentative bacteria resistance in hospitals should be strengthened Monitoring, to develop a reasonable clinical strategy.