2007-2009年鲍曼不动杆菌的耐药性分析

Drug resistance of Acinetobacter baumannii,2007-2009

目的探讨2007年1月至2009年6月浙江省乐清市人民医院检出的鲍曼不动杆菌(AB)对常用抗生素的耐药性变化趋势,以指导临床合理选用抗生素。方法对该院2007年1月至2009年6月分离的非重复的革兰阴性杆菌使用法国生物梅里埃公司ATB细菌鉴定仪鉴定菌种,并做药敏试验,以明确AB对常用抗菌药物的体外耐药情况。结果 220株AB中85株来自重症监护病房(ICU),85%分离自痰标本。哌拉西林的耐药率从19.5%上升至66.7%。头孢噻肟、头孢他啶和头孢吡肟的耐药率从10%左右上升到60%以上。头孢呋辛的耐药率2008年达到97.7%。亚胺培南的耐药率从5.2%上升至56.1%。氨基糖苷类和喹诺酮类的耐药率均增高。从ICU分离到的AB比非ICU的AB的耐药率普遍高30%以上。结论 AB对多种抗菌药物耐药性迅速上升。应改善医疗环境条件,增强医务人员无菌观念,合理使用抗菌药物,加强对该菌耐药性的监测,以延缓耐药菌株上升,预防和控制病区内AB流行。

Objective To identify the changing trends of the drug resistance of Acinetobacter baumannii （AB）,isolated in Yueqing People＇s Hospital in Zhejiang from January 2007 to June 2009,against commonly used antibiotics,providing the basis for proper administration in clinical practice.Methods Each of the particular Gram-negative bacillus strains isolated in the hospital from January 2007 to June 2009 was identified using the BioMerieux ATB identification system.Susceptibility test was conducted to determine the resistance of AB to commonly used antibiotics ex vivo.Results Among 220 AB isolates,85 were from the intensive care unit （ICU）,and 85% from sputum specimens.The resistance rate to piperacillin increased to 66.7% from 19.5%,and those to cefotaxime,ceftazidime and cefepime increased to above 60% from about 10%.The resistance rate to cefuroxime reached 97.7% in 2008,and the result to imipenem increased to 56.1% from 5.2%.Increase in the resistance rates to aminoglycoside and quinolones was also noticed.Generally,ICU isolates had a resistance rate at least 30% higher than non-ICU strains.Conclusion The drug resistance rate of Acinetobacter baumannii was skyrocketing to multiple antibiotics.Therefore,it is essential to improve the health care conditions and septic awareness among medical workers,standardize antibiotic administration and enhance the resistance surveillance of AB isolates to curb the spread of resistant strains and to prevent nosocomial AB prevalence.