综合性医院ICU鲍曼不动杆菌分布及耐药性变迁分析

Distribution and drug resistance analysis of Acinetobacter baumannii in intensive care unit of a general hospital

目的分析某综合性医院重症监护病房(ICU)患者各类感染标本中鲍曼不动杆菌的分布及对抗菌药物的耐药情况,为指导临床合理使用抗菌药物,提高疗效提供指导依据。方法对2010年1月至2012年12月第四军医大学西京医院ICU患者各类感染性标本分离的病原菌4633株(2010年1413株,2011年1566株,2012年1654株)资料进行回顾性分析。结果 4633株病原株中鲍曼不动杆菌为1054株,在所统计的2010年至2012年份中,其所占比例分别为20.57%、21.26%及25.94%。鲍曼不动杆菌在标本中的分布以痰液为主,占所有感染性标本的80%以上(2010年87.3%、2011年80.2%、2012年83.5%)。在药敏结果中,鲍曼不动杆菌耐药性最低的是多粘菌素B,2010年至2012年分别为3.1%、1.5%、2.1%;其次为米诺环素和头孢哌酮/舒巴坦,分别为39.4%、34.2%、8.2%和26.7%、47.1%、43.1%;对其他抗菌药物耐药率较高,均在60%以上,其中对亚胺培南和美罗培南耐药率呈现逐年上升趋势,在2010年至2012年分别为71.6%、76.0%、84.6%和68.8%、75.7%、84.1%。结论鲍曼不动杆菌主要引起呼吸道感染,其对大部分抗菌药物耐药情况严重,治疗上应根据药敏结果选择敏感抗菌药物,加强抗菌药物合理使用。

Objective To analyze distribution and drug resistance of Acinetobacter baumannii in various infections samples of intensive care unit（ICU）,and to provide guidance for fair use of antibiotics and improving efficacy.Methods A total of 4633 strains in various infections samples of ICU from Jan 2010 to Dec 2012 were retrospectively analyzed（1413 strains in 2010,1566 strains in 2011,1656 strains in 2012）.Results Acinetobacter baumannii proportion was 20.57%,21.26%,and 25.94% respectively during 2010 to 2012.The main distribution of Acinetobacter baumannii was in sputum specimens,which accounts for more than 80% in all infectious specimens （87.3% in 2010,80.2% in 2011,83.5% in 2012）.The results of drug sensitivity test showed Polymyxin B had the lowest drug resistance of Acinetobacter baumannii.The resistance rate of Acinetobacter baumannii to Polymyxin B was 3.1% in 2010,1.5% in 2011,2.1% in 2012.Minocycline and Cefoperazone/sulbactam had the lower drug resistance of Acinetobacter baumannii.The resistance of Acinetobacter baumannii to other antimicrobial drugs was higher and the resistance rates were all more than 60%.The resistance rate of Acinetobacter baumannii to imipenem and meropenem showed an increasing trend.To imipenem,the resistance rate was 71.6%,76.0% and 84.6% respectively in the three years.And to meropenem,the resistance rate of Acinetobacter baamannii was 68.8%,75.7% and 84.1%.Conclusions Acinetobacter baumannii main cause respiratory infections.The drug resistance of Acinetobacter baumannii is serious to most antimicrobial.The priority should be given to those antibacterials to which the pathogens are susceptible.Attention should be paid to using antibacterials rationally.