连续18年的鲍氏不动杆菌耐药变迁及不同来源分布

Drug resistance of Acinetobacter baumanniifrom different specimens sources during 18 consecutive years

目的调查18年中临床分离的鲍氏不动杆菌耐药性变迁和来源分布,为临床治疗鲍氏不动杆菌感染提供依据。方法细菌鉴定采用法国生物梅里埃公司的VITEK-60全自动微生物鉴定系统,药物敏感性试验采用K-B纸片扩散法,结果判定按照CLSI标准,数据分析采用WHONET5.6和EXCEL软件处理。结果 18年中共分离到鲍氏不动杆菌4140株,分离菌株数和分离率呈不断增加趋势,从1994年37株升至2011年的534株,主要来源于呼吸道标本,占77.6%;鲍氏不动杆菌对17种抗菌药物的耐药率呈逐年增加趋势,上升最明显的是碳青霉烯类抗菌药物,耐药率从0上升至>80.0%;不同标本来源的鲍氏不动杆菌对17种抗菌药物的耐药率略有不同,其中导管标本对17种抗菌药物的耐药率最高,耐药率从61.0%～96.0%,而尿标本对17种抗菌药物有较高的敏感性,耐药率为31.6%～82.6%,不同标本对庆大霉素、亚胺培南、左氧氟沙星、米诺环素、四环素有较高的敏感性。结论连续监测鲍氏不动杆菌的来源分布和耐药变迁,对临床感染控制和治疗具有重要的意义。

OBJECTIVE To investigate the change of drug resistance and the distribution of clinical isolates of Acinetobacter baumannii from different specimens sources during 18 consecutive years so as to guide clinical therapy. METHODS The susceptibility of antibiotics was determined by K-B test, following the identification of A. baumanni by VITEK 60 based on clinical and laboratory standards institute （CLSI） guideline. Data analysis was conducted by WHONET5. 6 and EXCEL. RESULTS A total of 4140 strains of A. baumanni were isolated during this period with increasing strains and isolation rate, increasing from 37 strains in 1994 to 534 strains in 2011 ,the strains were mainly isolated from the respiratory tract specimens, accounting for 77. 63%; the drug resistance rates of the A. baumannii strains to 17 antimicrobial agents increased year by year during this period, the most significant increase was the drug resistance rate to the carbapenems which increased from 0 to 80 above; the A. baumannii strains isolated from the different specimens sources varied in the drug resistance rate to the 17 antibiotics, the drug resistance rate of the strains isolated from the catheter specimens was the highest, ranging from 61.0% to 96.0%, but the strains isolated from the urine specimens were highly susceptible to the 17 antibiotics with the drug resistance rate varying from 31. 6% to 82. 6%. The strains isolated from different specimens sources showed relatively high susceptibility to gentamicin, imipenem, levofloxacin, tetracycline, and minoelycline. CONCLUSION It is of great significance in the clinical control and treatment of infections to consecutively monitor the distribution and drug resistance of the A. baumaunii.