鲍氏不动杆菌的临床分布及产酶耐药表型研究

Clinical distribution and drug resistance phenotype of Acinetobacter baumannii

目的探讨鲍氏不动杆菌(ABA)在临床各病区的分布及耐药表型的流行特点,指导临床合理使用抗菌药物。方法对临床标本进行分离鉴定,采用K-B法对常规药物进行耐药检测,用CLSI推荐的双纸片扩散法检测ESBLs酶、协同法检测金属酶,三维法检测AmpC酶。结果 103株ABA对临床常规药物有不同程度耐药,对一～三代头孢菌素高度耐药,达54.3%～100.0%,其次是环丙沙星、头孢吡肟分别是49.5%、30.1%,对头孢哌酮/舒巴坦、亚胺培南、多黏菌素B、利福平耐药率最低;103株ABA中产酶菌株62株,占60.2%,产酶菌株中,单产ESBLs酶13株,占20.9%,单产AmpC酶34株,占51.6%,产SSBL酶14株,占24.2%,产MBL酶3株,占4.84%。结论该研究ABA呈现多药耐药性,产酶菌株主要是AmpC酶、ESBLs酶为主,产酶菌株与非产酶菌株在头孢哌酮/舒巴坦、头孢吡肟敏感性有明显差异。

OBJECTIVE To understand the clinical distribution of Acinetobacter baumannii in clinical wards and prevalence characteristics of drug resistant phenotypes,so as to guide the rational use of antimicrobial agents in clinics.METHODS Clinical samples were isolated and identified.Drug resistance to conventional drugs was determined by using KB method.Double-disc diffusion method recommended by CLSI was adopted to detect ESBLs enzymes.Synergy testing was used to measure metal enzymes and three-dimensional enzyme assay for AMPC.RESULTS A total of 103 A.baumannii isolates presented various degrees of resistance to conventional drugs,with high-level resistance to the first,second and third-generation cephalosporins,reaching 54.3%-100.0%,followed by ciprofloxacin and cefepime with the resistance rates of 49.5% and 30.1%.The resistance rates to cefoperazone/sulbactum,imipenem,polymyxin B and rifampin were the lowest.Of 103 strains of A.baumannii,enzyme-producing bacteria were 62 strains（60.2%）;of enzyme-producing bacteria,13 strains（20.9%） were ESBLs-producing isolates,34 strains（51.6%） were AmpC-producing isolates,14 strains（24.2%） were SSBL-producing isolates,3 strains（4.84%） were MBL-producing isolates.CONCLUSION A.baumannii analyzed in this study shows multidrug resistance.enzyme-producing strains are mainly AmpC-producing and ESBLs-producing.There is significant difference in susceptibilities to cefoperazone/sulbactum and cefepime between the enzyme-producing and non-enzyme-producing isolates.