某院鲍曼不动杆菌感染的分布及耐药性分析

Analysis on antimicrobial resistance and distribution of Acinetobacter baumannii infection in our hospital

目的：分析上海中医药大学附属曙光医院2008～2013年临床住院患者标本分离的鲍曼不动杆菌分布特点及其耐药情况，为临床合理应用抗菌药物提供依据。方法采用全自动微生物分析仪 BD phoenix-100对该院2008年9月至2013年9月临床分离的鲍曼不动杆菌进行菌种鉴定和最低抑菌浓度（MIC）测定，对所有数据进行分析。结果自2008年9月至2013年9月，历年分离的鲍曼不动杆菌依次为128、173、350、282、186株，以2012整年抽样查得临床分离的鲍曼不动杆菌菌株主要来源于痰标本（155株，68．28％）；病房主要集中于重症监护病房（65株，28．63％），其次是呼吸科（47株，20．70％）、急诊留观（35株，15．42％）、中风老年科病房（24株，10．57％），患者也多见于60岁以上老年人。根据5年内数据，多种不同抗菌药物的耐药率普遍增高，特别是2011～2012年间上升趋势更明显，青霉素类抗菌药物呈全耐药性。对第3、4代头孢菌素类、氨基糖苷类、喹诺酮类抗菌药物也表现普遍耐药。头孢菌素类（头孢他啶、头孢噻肟、头孢吡肟）抗菌药物耐药率保持在75．00％～85．00％较高水平，喹诺酮类（环丙沙星、左氧氟沙星）与氨基糖苷类（庆大霉素、阿米卡星）抗菌药物耐药率也呈逐年递增态势；对β-内酰胺类复方制剂耐药率增长速度较快，如氨苄西林/舒巴坦从60．16％增长至83．33％。其中碳青霉烯类抗菌药物亚胺培南、美洛培南耐药率增长幅度也非常明显，亚胺培南从25．20％上升最高到82．27％，并且检出率不断增加。舒普森由18．89％上升至80．00％，而唯一不同的是克里斯丁（多黏菌素 E）5年来一直保持低耐药率。结论鲍曼不动杆菌对各种抗菌药物的耐药性逐渐增强，多重耐药和泛耐药鲍曼不动杆菌分离率逐年增高，应警惕并高度重视该菌感染及耐药监测，以减少耐药菌株的产生和播散。

Objective To analyze the distribution characteristics and antimicrobial resistance of isolated Acinetobacter（A.）bau-mannii from the clinical inpatients in our hospital from 2008 to 2013 to provide the basis for rational use of antibacterial drugs in clinic.Methods The BD phoenix-100 fully automatic microbial analyzer（USA）was adopted to conduct the strain identification and the minimal inhibitory concentration（MIC）detection of clinically isolated A.baumannii.All obtained data were analyzed.Results 128,173,350,282,186 strains of A.baumannii in turn were isolated during these years,the strains in sampling from the clinically i-solated A.baumannii during 2012 was mainly originated from the sputum samples（155 strains,68.28%）.In the distribution of hos-pital departments,most concentrated in ICU（65 strains,28.63%）,followed by the respiratory department（47 strains,20.70%）,the emergency observation wards（35 strains,15.42%）and the apoplexy and geriatric wards（24 strains,10.57%）,the most of patients were older people aged more than 60 years.And according to the data within these 5 years,many kinds of different antibacterial drugs had generally the increased drug resistance rate,especially the increasing trend during 2011-2012 was more obvious,the pen-icillins all showed extensive drug-resistance.In the third,fourth generation cephalosporins,aminoglycosides and quinolones were generally drug-resistant.The drug resistance rate of cephalosporins（ceftazidime,cefotaxime,cefepime）remained at a higher level of 75.00%-85.00%.The drug resistance rate of quinolones（ciprofloxacin,levofloxacin）and aminoglycosides（gentamicin,amikacin） also showed the increasing trend year after year.The drug-resistant rate of the beta lactam compound preparations had the rapidly increasing speed,such as which of ampicillin /sulbactam was increased from 60.16% to 83.33%,which of carbapenems such as imipenem and meropenem was increased more significantly,the drug-resistant rate of imipenem was increased from 25.20% to 82.27%,and the detection rate was continually increased.And the drug resistant rate of Schupson was increased from 18.89% to 80%,but the only difference was the drug named Colistin（polymyxin E）maintained a low drug resistance rate during these five years.Conclusion Resistance of A.baumannii to various antibacterial drugs is gradually increased and the isolation rate of multi-drug-resistant and pan-drug resistant A.baumannii is increased year by year.So A.baumannii infection and its drug-resistance changes should be vigilant and be paid more attention to for preventing the emergence and spread of drug-resistant A.baumannii strains.