神经科病房鲍曼不动杆菌的分布及耐药性分析

Analysis of distribution and drug resistance of Acinetobacter baumannii in neurology ward

目的了解神经科病房鲍曼不动杆菌的分布及耐药性。方法回顾性分析2009年1月—2014年3月神经科病房分离出的269株鲍曼不动杆菌的分布和耐药性;细菌鉴定和药敏试验采用VITEK2 Compact全自动细菌培养鉴定仪;数据采用WHONET5.6软件进行统计分析,耐药率的比较采用χ2检验。结果神经内科分离鲍曼不动杆菌的数量高于神经外科和神经重症监护病房,标本来源主要为痰液(97.4%);耐亚胺培南鲍曼不动杆菌(IRAB)的分离率为54.3%;鲍曼不动杆菌除对阿米卡星的耐药率较低(20.7%),对亚胺培南和哌拉西林-他唑巴坦的耐药率已高达54.3%和55.0%;IRAB对甲氧苄啶-磺胺甲口恶唑的耐药率(72.6%)低于非IRAB(89.4%),差异有统计学意义(P<0.05);对其他抗菌药物的耐药率IRAB明显高于非IRAB,差异有统计学意义(P<0.05)。结论神经科病房鲍曼不动杆菌和IRAB的分离率和耐药性较高,应加强耐药性监测,合理选用抗菌药物,有效控制多重耐药鲍曼不动杆菌的感染及流行。

Objective To examine the distribution and antibiotic resistance of the Acinetobacter baumannii strains isolated from Department of Neurology. Methods A retrospective review was conducted for the 269 strains of A. baumannii isolated during the period from January 2009 to March 2014. VITEK 2 Compact system was used for bacteria identification and antimicrobial susceptibility testing. The data were analyzed with WHONET 5. 6 software and compared by Chi-square test. Results The prevalence of A. baumannii was higher in Department of Neurology than in Department of Neurosurgery or Neurology ICU. Majority （97.4%） of the A. baumannii strains were isolated from sputum. About 54.3% of the A. baumannii isolates were resistant to imipenem. Relatively lower percentage of the A. baumannii isolates were resistant to amikacin （20.7%）, but as high as 54.3% and 55.0% of the strains were resistant to imipenem and piperacillin tazobactam. More imipenem non-resistant A. baumannii strains （89.4%） were resistant to trimetboprim-sulfamethoxazole than imipenem resistant A. baumannii （72. 6%） （P〈0. 05）. However, to the other antimicrobial agents tested, imipenem- resistant A. baumannii strains showed significantly higher resistance rate than imipenem nomresistant A. baumannii strains （P〈0.05）. Conclusions The prevalence of A. baumannii and imipenem resistant A. baurnannii is high in Department of Neurology. Further monitoring of antibiotic resistance and rational use of antimicrobial agents are helpful to effectively control the epidemic of multidrug-resistant A. baumannii.