多重耐药鲍曼不动杆菌的临床分布特征及耐药性分析

Clinical distribution and drug resistance analysis of multidrug-resistant Acinetobacter baumannii

目的动态监测多重耐药鲍曼不动杆菌分布及耐药性变迁,指导临床合理用药。方法收集2011年1月至2013年12月本院住院患者各类送检标本,采用DL-96细菌测定系统进行细菌鉴定及药敏试验。结果共分离出多重耐药鲍曼不动杆菌220株,检出率逐年上升,主要分布在ICU(35.9%)、老年病内科(16.8%)和呼吸内科(13.2%);60岁以上患者检出占76.8%;在痰液中共检出170株,占77.3%。多重耐药鲍曼不动杆菌除米诺环素的耐药率21.8%较低外,其他抗菌药物的耐药率均在60.0%以上,特别是头孢菌素的耐药率已达90.0%以上。对于多重耐药鲍曼不动杆菌的治疗临床应根据药敏结果采用两药联合或三药联合。结论制定合理有效的感染控制措施,合理使用广谱抗菌药物,避免及减少多重耐药鲍曼不动杆菌菌株医院感染的暴发流行。

Objective To investigate the distribution and the changes in drug resistance of multidrug-resistant Acinetobacter baumannii dynamically, and to guide the rational use of antibiotics. Methods Pathogens isolated from the specimens of inpatients in our hospital since January 2011 to December 2013 were cultured, pathogens identification and drug susceptibility test were performed by DL-96 microorganism analyze system. Results Total of 220 strains of multidrug-resistant Acinetobacter baumannii were isolated, and the detection rate increased year by year. The 220 strains of Acinetobacter baurnannii mainly distributed in ICU department （35.9%）, geriatrics department （16.8%） and respiratory department （13.2%）. There were 76.8% of Acinetobacter baumannii isolated from inpatients over 60 years old and 77.3% isolated from phlegm specimens （170 strains）. The resistance rate of multidrug-resistant Acinetobacter baumannii to minocycline was low as 21.8%, but it were more than 60% to other antibiotics. In particular to cephalosporin, the resistance rate of Acinetobacter baumannii reached to above 90.0%. The two or three- drug combination should be taked based on susceptibility of drug for the treatment of multidrug-resistant Acinetobacter baumannii. Conclusions The reasonable and effective measures should be taked to control infection, and use broad-spectrum antibiotics rationally to prevent and reduce nosocomial infection outbreak caused by multidrug-resistant Acinetobacter baumannii.