目的：了解下呼吸道多重耐药非发酵菌临床分布及耐药情况，为合理应用抗菌药物提供依据。方法菌株来自2012年1月~2014年1月本院呼吸科送检的590例下呼吸道标本进行细菌学培养，菌种采用法国生物梅里埃公司API系统进行细菌鉴定，采用K-B纸片扩散法进行药敏试验，使用WHONET 5.5软件作统计分析。结果本院呼吸科送检的590例下呼吸道标本中共分离出病原菌160株（同一患者的多次分离株只做1次分离），其中铜绿假单胞菌107株，占66.88%，鲍曼不动杆菌18株，占11.25%，嗜麦芽窄食单胞菌11株，占6.88%。铜绿假单胞菌抗生素耐药率从高到低依次为氨苄西林/舒巴坦100.0%、四环素90.0%、氯霉素83.0%、头孢噻肟71.4%、氨曲南50.0%、哌拉西林47.2%、庆大霉素42.2%、头孢他定38.6%、头孢哌酮36.4%、左氧氟沙星32.6%、头孢吡肟29.4%、阿米卡星28.9%、哌拉西林/他唑巴坦6.2%、亚胺培南0%、多黏菌素E 0%。鲍曼不动杆菌属耐药率从高到低依次为头孢哌酮100.0%、头孢噻肟100.0%、头孢吡肟100.0%、头孢他定87.5%、哌拉西林87.5%、庆大霉素83.5%、四环素80.0%、氨曲南75.0%、氯霉素71.4%、左氧氟沙星66.7%、阿米卡星28.6%。嗜麦芽窄食单胞菌耐药率从高到低依次为氨苄西林/舒巴坦100.0%、四环素100.0%、氯霉素100.0%、头孢噻肟100.0%、氨曲南100.0%、哌拉西林100.0%、庆大霉素100.0%、阿米卡星100.0%、哌拉西林/他唑巴坦100.0%、头孢他定75.0%、亚胺培南66.6%、头孢吡肟60.0%、多黏菌素E 33.3%、左氧氟沙星25.0%、复方磺胺甲恶唑0%。结论下呼吸道多重耐药非发酵菌以铜绿假单胞菌为主，对抗菌药物呈多重耐药，临床应及时采集标本，作病原学检测及药敏试验，并根据药敏试验结果合理选用抗菌药物，以提高诊疗效果。%Objective To understand the clinical distribution and drug resistance of multi-drug resistent non-fermenta-tive bacteria in lower respiratory infection,and to provide evidence for proper application of antibiotic drugs. Methods The bacterial straln was from 590 samples of lower respiratory tract which were tested in the Department of Respiratory Medicine in our hospital from January 2012 to January 2014 and were cultured bacteriologically.The bacterial species were identified by the API system from BioMérieux,a French company.Drug sensitive test was performed via Kirby-Bauer disk diffusion,and a statistical analysis was carried out by the software of WHONET 5.5. Results Among 590 samples of lower respiratory tract tested in the Department of Respiratory Medicine in our hospital,a total of 160 pathogenic bacteria were isolated (one isolation was carried out for multiple isolates in same patient).Among them,107 stralns were Pseudomonas aeruginosa,accounting for 66.88%,18 stralns were Acinetobacter baumannii,accounting for 11.25%,and 11 stralns were Stenotrophomonas maltophilia,accounting for 6.88%.Antibiotic drug resistance rate of Pseu-domonas aeruginosa from high to low was ampicillin/sulbactam 100.0%,tetracycline 90.0%,chloramphenicol 83.0%,ce-fotaxime 71.4%,aztreonam 50.0%,piperacillin 47.2%,gentamicin 42.2%,ceftazidime 38.6%,cefoperazone 36.4%,lev-ofloxacin 32.6%,cefepime 29.4%,amikacin 28.9%,piperacillin/tazobactam 6.2%,imipenem 0%,polymyxin E 0%.Antibi-otic drug resistance rate of Acinetobacter baumannii was cefoperazone 100.0%,cefotaxime 100.0%,cefepime 100.0%, ceftazidime 87.5%,piperacillin 87.5%,gentamicin 83.5%,tetracycline 80.0%,aztreonam 75.0%,chloramphenicol 71.4%, levofloxacin 66.7%,amikacin 28.6%.Antibiotic drug resistance rate of Stenotrophomonas maltophilia was ampicillin/sul-bactam 100.0%,tetracycline 100.0%,chloramphenicol 100.0%,cefotaxime 100.0%,aztreonam 100.0%,piperacillin 100.0%, gentamicin 100.0%,amikacin 100.0%,piperacillin/tazobactam 100.0%,ceftazidime 75.0%,imipenem 66.6%,cefepime 60.0%,polymyxin E 33.3%,levofloxacin 25.0%,cotrimoxazole 0%. Conclusion Multi-drug resistent non-fermentative bacteria in lower respiratory tract is malnly Pseudomonas aeruginosa,which shows multi-drug resistance to antibiotics. Samples should be collected timely in clinical settings,pathogenic test and drug sensitive test should be carried out,and antibiotics should be properly applied according to the results of drug sensitivity test,so as to enhance the efficacy of treatment and diagnosis.
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