肺炎克雷伯菌和鲍曼不动杆菌的耐药性分布差异研究

Research of Klebsiella Pneumoniae and Acinetobacter Baumannii Resistance Distribution Differences

目的了解我院近5年来临床常见的肺炎克雷伯菌和鲍曼不动杆菌耐药性的动态变化情况以及在不同标本间的差异。方法采用回顾性分析方法,对2007年10月-2012年9月临床临床分离的肺炎克雷伯菌和鲍曼不动杆菌对21种抗菌药物的耐药情况进行统计分析。结果肺炎克雷伯菌和鲍曼不动杆菌的临床分离株数量呈逐年上升的趋势。抗生素的耐药率处于总体下降的趋势,而且部分抗生素耐药率下降变化有统计学差异(P<0.05),但是鲍曼不动杆菌近一年内耐药性升高明显;部分抗生素的耐药性出现波动性变化。从痰标本和血标本分离的鲍曼不动杆菌的耐药率均没有统计学差异(P>0.05),而肺炎克雷伯菌却有8种抗生素的耐药率出现了统计学差异(P<0.05)。从呼吸内科和ICU痰标本分离的鲍曼不动杆菌的耐药率均有统计学差异(P<0.01),而肺炎克雷伯菌仅有氨苄西林、哌拉西林和亚胺培南3种抗生素的耐药率没有统计学差异(P>0.05),其他均有统计学差异(P<0.01)。结论抗生素的耐药率处于下降的趋势,说明抗生素使用的控制措施有了成效;肺炎克雷伯菌和鲍曼不动杆菌的耐药情况因来自不同标本和不同科室发生不同的变化,对指导临床用药有重要意义。鲍曼不动杆菌作为院感的常见细菌,形式不容乐观,加强院感控制工作迫在眉睫。

Objective To investigate the resistance dynamic changes of Klebsiella pneumoniae and Acinetobacter baumanni for the past five years in our hospital,and resistance differences between different specimens.Methods By the retrospective analysis methods,statistical analysis of 21 kinds of antimicrobial resistance to Klebsiella pneumoniae and Acinetobacter baumanni from October 2007 to September 2012.Results Numbers of clinical isolates of Klebsiella pneumoniae and Acinetobacter baumanni showed an increasing trend.Antibiotic resistance rate was in a downward trend,and the changes had significant differences in part（P0.05）,however Acinetobacter baumanni resistance in the past year increased significantly;volatile changes in the resistance to most of antibiotics.The resistance rate of Acinetobacter baumanni isolated from sputum specimens and blood samples was not statistically significant（P0.05）,but to Klebsiella pneumoniae there was a statistically significant difference for eight kinds of antibiotics（P0.05）.The resistance rate of Acinetobacter baumanni isolated from the Department of Respiratory Medicine and ICU sputum specimens was a statistically significant difference（P0.01）,and Klebsiella pneumoniae had a statistically significant difference（P0.01） except for ampicillin,piperacillin and imipemem.Conclusion Antibiotic resistance rate is in a downward trend,the control measures of antibiotic use appears effective.It is important to guide clinical therapy that different changes in the resistance of Klebsiella pneumoniae and Acinetobacter baumanni from different samples and different departments.Acinetobacter baumannii as a common hospital infection bacteria,the situation is unoptimistic,to strengthen the hospital infection control work is imminent.