174株鲍曼/醋酸钙不动杆菌复合体临床分布及耐药性分析

Analysis of Clinical Distribution and Antibiotic Resistance of 174 Strains of A. calcoaceticus-A. baumannii complex

目的了解鲍曼/醋酸钙不动杆菌复合体(A.calcoaceticus-A.baumannii complex,ACB complex)在笔者医院各临床科室的分布情况及其耐药性,为临床合理使用抗菌药物提供依据。方法所有菌株均采用VITEK2-compact全自动微生物分析仪进行菌种鉴定及药敏分析。结果 174株ACB complex主要来源于ICU病区(53.5%),其次为成人外科病区(24.1%)和儿科病区(12.1%)。标本类型主要为痰液(81.2%)、血液(占5.2%)、创口渗出物(占4.0%)等。ACB complex对呋喃妥因、头孢唑林耐药率最高,达100%,而对头孢哌酮/舒巴坦的耐药率仅为1.2%。此外,本研究资料显示,耐亚胺培南ACB complex均为多重耐药菌株,约占所有菌株的46%。其中分离于成人患者的ACB complex对亚胺培南的耐药率为62.9%,而新生儿及儿童的ACB complex对其耐药率分别为6.7%和14%。结论笔者医院ACB complex主要分布于ICU病区,且耐药率高。多重耐药ACB complex已出现于儿科病区,应引起临床医师的足够重视,定期监测ACB complex临床分布和耐药情况,可为临床合理使用抗菌药物提供依据。

Objective To investigate the distribution and drug sensitivity instance of A. calcoaceticus - A. baumannii complex in Yuying Children＇s Hospital Affiliated to Wenzhou Medical University, so as to prevent and control the nosocomial infections. Methods Isolates of A. calcoaceticus - A. baumannii complex were collected between November 2012 and May 2013 in our hospital. The data were analyzed by WHONET 5.6 software. Results A total of 174 strains of A. calcoaceticus - A. baumannii complex were analyzed, of which 142（81.2% ） were isolated from sputum, 9（5.2% ） from blood, 7（4.0% ） from wound. Most of the strains were isolated from the fol- lowing departments ： ICU （ 93,53.5 % ）, surgical department （ 42,24.1% ） and pediatrics department （ 21,12.1% ）. The antimicrobial sus- ceptibility testing revealed that the lowest resistance rate of A. calcoaceticus - A. baumannii was 1.2% to cefoperazone - sulbactam, and highest 100% to macrodantin and cefazolin. About 46% of these A. calcoaceticus - A. baumannii strains were resistant to imipenem. Conclusion Clinical A. calcoaceticus - A. baumannii are mainly isolated from sputum, most of which were from ICU. The supervision of the reasonable application of antimicrobial drugs should be strengthened, and nosocomial infections should be controlled to ensure medical safety.