2007-2009年不动杆菌检出情况及耐药性分析

Analysis of the Distribution and Drug Resistance of Acinetobacter between 2007 to 2009

目的了解近三年不动杆菌的临床分布及耐药性变迁情况,为临床合理用药提供依据。方法采用回顾性调查方法 ,对2007-2009年临床分离的不动杆菌的临床分布及耐药性变迁情况进行统计分析,菌株鉴定和药物敏感试验方法采用法国梅里埃WITEK2系统并分别用K-B法和E-test法测定48株不动杆菌对米诺环素和多粘菌素的敏感性。结果 230株不动杆菌中鲍曼不动杆菌所占比例最高,为93%(214/230)。主要分离自痰标本(203/230),以呼吸内科和ICU最多见,分别占36.5%和14.3%。2007-2009年不动杆菌年分离率分别为5.1%(53/1039)、6.4%(81/1266)和7.3%(96/1307),呈逐年增高的趋势,耐药率较低的有亚胺培南5.7%(2009年)、阿米卡星9.2%(2009年),耐药率较高的有环丙沙星50.6%(2009年)和复方新诺明47.1%(2009年),而且耐药率有逐年上升趋势。多重耐药菌株分离率2007年为11.3%(6/53),2008年为24.7%(20/81),2009年为35.4%(34/96),其中泛耐药株2007年0株,2008年2(2.5%)株,2009年4(4.2%)株。48株不动杆菌对米诺环素敏感率为52.1%,多粘菌素敏感率为100%。结论本院分离的不动杆菌以鲍曼不动杆菌为主,大多数来自痰标本,主要来源于呼吸内科和ICU,分离率有逐年增高的趋势,且耐药率、多重耐药株及泛耐药株均有上升趋势,值得临床高度重视。

Objective To investigate the clinical distribution and the variation of drug resistance of Acinetobacter.Methods Acinetobacter collected between 2007 to 2009 were retrospectively analysed.Kirby-Bauer method and E-test were used to detect the sensitivity of Acinetobacter to polymyxin and minocycline,respectively.Results 214 strains of A.baumannii were isolated from 230 samples of Acinetobacter.203 strains were isolated from sputum,and the samples were mainly obtained from the Department of Respiratory Medicine（36.5%）and ICU（14.3%）.The isolation rate of Acinetobacter in 2007,2008 and 2009 was 5.1%（53 / 1039）,6.4%（81 / 1266）and 7.3%（96 / 1307）,respectively.For the IMI and AK,the drug resistant rates were 5.7% and 9.2%（2009）.For CIP and SXT,the drug resistant rates were 50.6% and 47.1%（2009）.The isolation rates of multi-drug resistant Acinetobacter were 11.3%（2007）,24.7%（2008） and 35.4%（2009）,and the number of pan-drug resistant Acinetobacter was 0（2007）,2（2008）and 4（2009）.Conclusions A.baumanniiis is the major Acinetobacter found in our hospital.Acinetobacter was mostly isolated from the sputum,and mainly distributed in the Department of Respiratory Medicine and ICU.The isolation rate was increasing between 2007 and 2009,and the drug resistant rate,multi-drug resistance and pan-drug resistance of Acinetobacter have the tendency of increasing.We should pay more attention on it.