瑞金医院重症监护病房和烧伤病房鲍曼不动杆菌的流行病学监测和分析

Monitoring and analyzing the prevalence of Acinetobacter baumannii strains isolated from intensive care units and burn ward in Ruijin Hospital

目的:监测并分析瑞金医院重症监护病房(ICU)及烧伤病房鲍曼不动杆菌(Acineto bacterbaumannii,Ab)的检出率和耐药率的变化趋势,为临床预防和治疗Ab感染提供临床依据。方法:采用细菌耐药监测软件WHONET5.4回顾分析我院呼吸重症监护病房(RICU)、外科重症监护病房(SICU)、急诊重症监护病房(EICU)和烧伤病房患者体液和导管标本中检出的Ab,应用脉冲场凝胶电泳(PFGE)对泛耐药鲍曼不动杆菌(PDR-Ab)进行同源性分析。结果:2006年1月至2008年12月从我院4个病房患者中检出332株Ab,2006至2008年分别为85株、111株、136株,其中来自血液株数占3.7%,导管株数占11.2%,伤口和创面株数占31.9%,痰液株数占46.7%。4个病房中,Ab是最常见的检出菌种之一。相对于2006年,2008年Ab对临床主要抗菌药物的耐药率有显著上升(P<0.05),其对头孢哌酮-舒巴坦的耐药率最低。3年内4个病房共检出PDR-Ab57株。2007年RICU检出4株PDR-Ab,通过临床资料和PFGE分析证实为同源菌株,结合临床资料分析,高度提示为交叉感染;2008年RICU检出2株PDR-Ab虽为同源菌株,但结合临床资料分析可排除交叉感染的可能。结论:Ab在ICU和烧伤病房都是重要的检出细菌之一,其对临床常用抗菌药物耐药率呈显著上升趋势。交叉感染可能是引起Ab检出率和耐药率上升的原因之一。

Objective To determine the detection rates and to follow the variation in resistance of. Acinetobacter baumannii （A.baumannii） isolated in ICUs and burn ward in Ruijin Hospital for improving the prevention and treatment of A.baumannii infection. Methods The data from A.baumannii isolated from respiratory intensive care unit, surgical intensive care unit, emergency intensive care unit and burn ward were analyzed by WHONET 5.4 software. The genetic relatedness of the pan-drng resistant A,baumanii was investigated by pulsed-field gel eleetrophoresis （PFGE）. Results A.baumannii （n=332） strains were isolated from blood （3.7%）, catheter （11.2%）, wound （31.9%）, sputum （46.7%） of patients in the three ICUs and burn ward from January 2006 to December 2008. A.baumannii was one of the most frequently detected bacteria in these four wards. The rising of resistance rate to antibacterials for A.baumannii isolates was statistically significant from 2008 to 2006 （P〈0.05）. The resistance rate of A.baumannii was the lowest to cefoperazone/ sulbactam. Fifty-seven strains of pan-drug resistant A.baumannii were detected from 2006 to 2008, of which the four strains isolated from RICU in 2007 belonged to one genotype. It denoted that possible cross-transmission might have occurred in RICU in 2007. The two strains of pan-drug resistant A.baumannii isolated in 2008 belonged to one genotype. However, ion could be excluded according to the clinical data. Conclusions A.baumannii is one of the most important microbials detected in intensive care units and burn ward. A.baumannii shows a rising resistance rate to antibacterials. Cross-transmission is probably one of the reasons for the rising of antimicrobial resistance rate. Effective strategy to control and prevent cross-transmission is one of the methods to reduce the occurrence and rising of antimierobial resistance rate of A.baumannii.