2008—2011年佛山市某医院重症监护病房鲍曼不动杆菌耐药性分析

Antibiotic resistance analysis of Acinetobacter baumannii in ICU of a hospital in Foshan City from 2008-2011

目的分析4年间重症监护病房(ICU)鲍曼不动杆菌的耐药情况及变化趋势,指导临床合理用药及预防耐药性增加。方法回顾分析2008年1月—2011年12月ICU分离的鲍曼不动杆菌的药敏结果,采用ATB鉴定药敏分析仪作鉴定和药敏试验。结果 4年间共分离鲍曼不动杆菌235株,主要来源于痰标本,占90.6%。药敏试验结果显示,鲍曼不动杆菌对多黏菌素E耐药率最低,为零;其次为碳青霉烯类,耐药率低于10%。对多数监测药物的耐药率有不同程度的下降,特别是对阿米卡星、妥布霉素的耐药率从2009年的73.9%下降至2010年的39.1%和40.2%(P<0.01),但大部分的抗菌药物耐药率仍大于50%。2011年碳青霉烯类耐药的鲍曼不动杆菌(CRAB)明显上升至9.7%(P<0.01)。结论碳青霉烯类抗生素对鲍曼不动杆菌仍保持很好的活性,但耐药性呈上升趋势,仍需采取切实有效的措施控制鲍曼不动杆菌在医院内的传播和暴发流行。

[Objective]To analyze antimicrobial resistance of the Acinetobacter baumannii in intensive care unit（ICU）in 4 years to guide rational drug use and prevent increased resistance.[Methods]The result of drug susceptibility of Acinetobacter baumannii from Jan 2008 to Dec 2011 in ICU were analyzed and studied retrospectively,using ATB system for identification and drug sensitivity analysis.[Results] A total of 235 strains of A.baumannii were isolated.The major strains（90.6%） were isolated from sputum.The antimicrobial susceptibility testing revealed the most sensitive antibiotics was polymyxin E,whose resistant rate was 0%,followed by carbapenems（lower than 10%）.Multiple antibiotic resistance rates had decreased in varying degrees,especially for amikacin,tobramycin,whose resistance rate decreased from 73.9% in 2009 to 22.6% and 24.2% in 2011（P0.01）.But most of the antimicrobial drug resistance rate was higher than 50%.9.7% of A.baumannii strains were resistant to carbapenems in 2011（P0.01）.[Conclusion]Carbapenems are still the most active agent to A.baumannii.However the antibiotic resistance appears rising trend.Effective measures should be taken to control the A.baumannii spread in hospital and prevent the outbreak and epidemic of nosocomial infections.