2014-2017年我院鲍曼不动杆菌分布及ICU内鲍曼不动杆菌耐药性分析

Analysis on the distribution of Acinetobacter baumannii in our hospital and the drug resistance of Acinetobacter baumannii in ICU from 2014 to 2017

目的:了解我院鲍曼不动杆菌临床分布情况及ICU内鲍曼不动杆菌的耐药性变迁,为临床指导用药、合理使用抗生素、预防耐药菌产生提供依据。方法:回顾性分析2014至2017年我院鲍曼不动杆菌分布及耐药情况,细菌药敏试验采用VITEK仪器法。结果:我院2014至2017年共分离出鲍曼不动杆菌2246株,各年度分别检出数量为:413株(2014年)、565株(2015年)、644株(2016年)和624株(2017年)。标本类型主要为痰,占88%,其次为胆汁及腹腔引流液,占5.7%,除此之外,血液、伤口分泌物、胸水及脑脊液等也分离出鲍曼不动杆菌。鲍曼不动杆菌在我院各科室分布广泛,其中,综合ICU检出比最高,占20%,其次为呼吸内科,占9.3%,其余临床科室也均有分布。我院ICU病房内鲍曼不动杆菌对多种抗菌药物均表现较高的耐药性,其中,左氧氟沙星耐药率最低,为23.16%,且呈现逐年降低趋势,差异具有统计学意义(P<0.05)。其次是阿米卡星,其耐药率为27.62%。头孢哌酮舒巴坦耐药率变化较大,2014~2016年呈逐年上升,但2017年较2016年明显下降,且差异具有统计学意义(P<0.05)。其他抗生素耐药率均在80%以上,近几年来变化不大。结论:鲍曼不动杆菌可造成多部位的感染,且临床科室分布广泛,并对临床多种常用抗生素均具有较高的耐药性。

Objective:To investigate the distribution of the Acinetobacter baumannii in our hospital and the change of antimicrobial resistance in ICU,and provide some rationalization proposal on clinical medication,antibiotics use and prevention of resistant bacteria.Methods:Retrospective analysis of the distribution and resistance of Ab in our hospital during 2014-2017 was made in this study.The VITEK instrument method was adopted in the bacterial susceptibility test.Results:Totally,2246 strains of Acinetobacter baumannii were isolated from our hospital,including 413 strains(2014 year),565 strains(2015 year),644 strains(2016 year),and 624 strains(2017 year).These bacteria were mainly derived from sputum samples,accounting for 88%.Bile and fluid of the peritoneal cavity accounted for 5.7%.In addition,the bacteria also was isolated from blood,wound secretions,pleuraleffusion and celebrospinal fluid.Ab is widely distributed in various departments of our hospital,of which thehighest is ICU accounting for 20%.The second is respiratory department about 9.3%and the other clinical departments also have the bacteria.Ab in the ICU of our hospital showed high resistance to various antibacterial drugs.Among them,the resistance to levofloxacin was the lowest(23.16%)and showed a de creasing trend year by year,andthe difference was statistically significant(P<0.05).The second was amikacin with the resistance rate of 27.62%.The drug resistance rate of cefoperazone-sulbactam changed greatly and increased year by year during 2014-2016,but declined noticeably in 2017 compared with 2016(P<0.05).Other antibiotic resistance rates are all above 80%,and have no obvious change in recent years.Conclusion:Ab can cause multiple site infection and are widely distributed in clinical departments and has high resistance rate to various commonly used antibiotics.