2002-2011年鲍曼不动杆菌临床分布及耐药性变迁分析

Analysis of Clinical Distribution and Transition of Drug Resistance of Acinetobacter Baumannii in the Year of 2002-2011

目的：探讨昆明市第一人民医院2002年1月-2011年12月临床分离鲍曼不动杆菌的临床分布、耐药性及变迁情况,指导临床合理用药。方法：采用Microscan Walkaway 40SI鉴定系统辅以传统手工方法鉴定细菌。采用K-B纸片琼脂扩散法进行体外药物敏感性试验,通过Whonet 5.6软件进行耐药性数据分析。结果：2002-2011年鲍曼不动杆菌高发于重症监护室（0~54株）,神经外科（4~50株）,呼吸科（3~37株）,消化科在2003年集中检出45株。检出标本包括痰液（86.2%）,肺泡灌洗液（1.5%）,血液（1.1%）。2002-2011年所检测的24种抗菌药物耐药率表现为氨苄西林、头孢唑林、头孢西丁10年来持续100%,庆大霉素为52.9%~62.9%,丁胺卡那为12.1%~62.5%,妥布霉素为16.7%~75%,氨苄西林-舒巴坦为0%~61.4%,头孢哌酮-舒巴坦为0%~50%,阿莫西林-克拉维酸为0%~66.9%,哌拉西林-他唑巴坦为33.3%~75%,替卡西林-克拉维酸为14.3%~75%,环丙沙星为42.9%~66.8%,氧氟沙星为57.1%~100%,左氧氟沙星为22.7%~82.4%,哌拉西林为37.5%~75%,头孢哌酮为36.6%~80.8%,头孢曲松为52%~74.1%,头孢他啶为38.2%~75%,头孢吡肟为38.5%~75%,氨曲南为0%~87.5%,亚胺培南为0%~58.8%,美罗培南为0%~12.5%,复方新诺明为20.9%~27.1%,米诺环素为0%~25%。结论：鲍曼不动杆菌分离数量逐年上升,易检出于患者呼吸不畅的科室,抗菌药物耐药严重且呈大幅度上升,并渐显多重耐药特性。

Objective： To investigate the clinical distribution , drug resistance and transition of Acinetobacter ba-mannii isolated by the first people hospital of Kunmming city from Jan . 2002 to Dec . 2011 , so as to provide a ref-erence for rational drug use in clinical practice . Methods： MicroScan WalkAway 40SI and conventional bacterial i-dentification assays were adopted for bacterial identification . The drug susceptibility test was conducted by K-B disc method and Whonet 5 . 6 software was used for the data analysis . Results： During 2002 - 2011 Acinetobacter bau-mannii was mostly detected in those departments such as ICU （ 0 ~ 54 strains ） , neurosurgery （ 4 ~ 50 strains ） and respiratory departments （ 3 ~ 37 strains ） . About 45 isolates was detected in digestion department in 2003 . The most numbers of isolates were found from sputum （ 86 . 2%） , balf （ 1 . 5%） and blood （ 1 . 1%） . The drug re-sistant rates of 24 kinds of antibiotics were observed including AMP 100%,CZO 100%,FOX 100%, GEN 52.9% ~62.9%,AMK 12.1% ~ 62.5%,TOB 16.7% ~ 75%,SAM 0% ~ 61.4%,CSL 0% ~ 50%,AMC 0% ~ 66.9%, TZP 33 . 3% ~ 75%, TCC 14 . 3% ~ 75%, CIP 42 . 9% ~ 66 . 8%, OFX 57 . 1% ~ 100%, LVX 22 . 7% ~ 82 . 4%, PIP 37.5% ~ 75%,CFP 36.6% ~ 80.8%,CRO 52% ~ 74.1%,CAZ 38.2% ~ 75%,FEP 38.5% ~ 75%,ATM 0% ~87 . 5%, IMP 0% ~ 58 . 8%, MEM 0% ~ 12 . 5%, SXT 20 . 9% ~ 27 . 1% and MNO 0% ~ 25%. Conclusion： The isolated numbers of Acinetobacter baumannii increased year by year and most were found in the areas where there were patients with shortness of breath . Antimicrobial drug resistance was serious and with an increasing trend , and the characteristics of multidrug resistance was found .