ICU医院感染鲍氏不动杆菌的耐药性变迁

Change of antimicrobial resistance of Acinetobacter baumanii causing nosocomial infections in ICU

目的探讨三级甲等医院ICU医院感染鲍氏不动杆菌(ABA)的耐药性变迁,为临床医师诊断和治疗疾病提供科学的实验室依据。方法对ICU 2009-2011年分离的346株ABA耐药性进行了回顾性调查分析,采集感染性标本进行细菌培养,ABA分离培养严格按《全国临床检验操作规程》进行;采用法国生物梅里埃公司生产的VITEK-32全自动微生物分析仪和相应鉴定试剂盒进行菌种鉴定;参照美国临床实验室标准化研究所(CLSI)推荐的纸片扩散法(K-B法)进行药敏试验,依据CLSI 2009-2011年折点判读结果。结果 ICU医院感染的ABA在呼吸道标本中检出率最高,为65.9%,其次是泌尿道标本;3年ABA对临床常用抗菌药物的耐药性呈逐年上升趋势,耐亚胺培南ABA检出率3年分别达到20.2%、21.6%、26.0%;ABA泛耐药菌株检出率3年分别达到20.2%、21.6%、24.4%。结论 3年ICU医院感染鲍氏不动杆菌的耐药性不断增长,应加强对多药耐药ABA的目标性监测,开展细菌耐药性的预警机制,控制ICU鲍氏不动杆菌耐药性快速上升的不良趋势。

OBJECTIVE To approach the change of antimicrobial resistance of Acinetobacter baumanii（ABA） causing nosocomial infections in intensive care unit（ICU） so as to provide the scientific evidence for clinical diagnosis and treatment.METHODS Retrospective review was performed for the antimicrobial resistance of 346 strains of ABA isolated from ICU in the past three years.Referring to National Guide to Clinical Laboratory Operation Procedures,the infective specimens were collected by aseptic technique for bacterial culture and isolation of ABA.VITEK 32 system（by Biomérieux,France） was used to identify the strains.The drug susceptibility testing was performed by K-B methods recommended by CLSI.The testing results were read according to CLSI2009-2011 breakpoints.RESULTS The detection rate of ABA isolated from the respiratory tract specimens was the highest（65.9%）,followed by the urinary tract specimens.The drug susceptibility testing results showed that the antimicrobial resistance of ABA kept an increasing trend in the past three years.The detection rates of imipenem-resistant strains during the three years were 20.2%,21.6%,and 26.0%,respectively.The detection rates of the pandrug-resistant ABA during the three years were 20.2%,21.6%,and 24.4%,respectively.CONCLUSION The drug resistance of ABA in ICU is increasingly growing in the past three years.The hospitals should strengthen the targeted monitoring of multidrug-resistant ABA and develop the warning mechanism of bacterial resistance so as to control the rapidly increasing resistance of ABA in ICU.