2012～2014年鲍曼不动杆菌感染的临床分布及耐药性检测

Clinical distribution and antimicrobial resistance detection of Acinetobacter baumannii infection during 2012-2014

目的了解鲍曼不动杆菌的临床分布及其对常用抗菌药物的耐药情况,为临床合理使用抗菌药物提供理论依据。方法对安化县人民医院2012～2014年临床分离出的206株鲍曼不动杆菌的临床分布与耐药情况进行分析。细菌鉴定由检验科完成,采用纸片扩散法进行药敏试验,结果按CLSI 2012标准判定。结果 2012～2014年共分离细菌2 803株,其中鲍曼不动杆菌206株,2012～2014年该菌分别占比6.71%、6.82%、8.19%,呈逐年上升趋势。标本主要分离自痰液（78.16%）,其次为尿液（7.28%）、肺泡灌洗液（6.80%）、伤口分泌物（3.40%）、血液（2.91%）。其感染患者主要分布于呼吸内科（40.29%）和神经外科（22.82%）。鲍曼不动杆菌对20种常用抗菌药物的检测结果显示耐药性普遍较高,其中3年耐药率升高最显著的药物依次为头孢他啶、复方磺胺甲噁唑、左氧氟沙星、哌拉西林、环丙沙星,而对美罗培南、亚胺培南、头孢哌酮/舒巴坦、头孢吡肟的3年耐药率均低于35%。结论鲍曼不动杆菌是医院感染中重要条件致病菌,且耐药率较高,应加强对鲍曼不动杆菌耐药性的监测,合理使用抗菌药物,阻止鲍曼不动杆菌耐药菌株在医院内定植和交叉传播。

Objective To understand the clinical distribution of Acinetobacter baumannii and its resistance to commonly used antibiotics so as to provide the theoretical basis for rational clinical use of antibacterial medicines.Methods The clinical distribution and drug resistance situation of 206 strains of clinically isolated Acinetobacter baumannii in the Anhua County People′s during2012-2014 were analyzed.The bacterial identification was completed by the department of clinical laboratory,the drug susceptibility test was performed by adopting the disk diffusion method,and the detection results were judged according to CLSI 2012 criteria.Results A total of 2 803 strains of bacteria were isolated during 2012-2014,including 206 strains of Acinetobacter baumannii.Its constituent ratios during this period were 6.71%,6.82% and 8.19%,showing the increasing trend year by year.The samples were mainly isolated from sputum（78.16%）,followed by urine（7.28%）,bronchoaleolar lavage fluid（6.80%）,wound secretion（3.40%）and blood（2.91%）.The infected patients were mainly distributed in the respiratory department（40.29%）and neurosurgery department（22.82%）.The detection results of Acinetobacter baumannii showed the higher resistance to 20 kinds of commonly used antibacterial drugs,in which the drugs with most significantly increase in 3-year drug resistance rate were in turn ceftazidime,cotrimoxazole,levofloxacin,piperacillin and ciprofloxacin,the 3-year resistance rate to meropenem,imipenem,cefoperazone/sulbactam and cefepime was less than 35%.Conclusion Acinetobacter baumannii is the major opportunistic pathogenic bacterium in nosocomial infection with higher drug resistance rate.It is necessary to strengthen the monitoring of Acinetobacter baumannii drug resistance and rationally use antibacterial medicines in order to stop the drug-resistant strains colonization and cross expansion in hospital.