重症监护病房鲍曼不动杆菌临床分布特征及耐药性变迁分析

Clinical distribution and drug resistance of Acinetobacter baumannii in intensive care unit

目的:探讨ICU内鲍曼不动杆菌分布特征及其对常用抗菌药物耐药性。方法:收集2012—2014年广州医科大学附属第二医院ICU临床标本分离的致病菌,描述致病菌株的菌种分布特征以及标本来源分布特征,分析ICU鲍曼不动杆菌耐药率的变迁,比较ICU与全院之间鲍曼不动杆菌耐药率的差异。结果:ICU检出的1 322株致病菌中鲍曼不动杆菌占首位,共751株(56.81%),其中分离自痰液或支气管吸取物共617株(82.16%);2012—2014年,ICU鲍曼不动杆菌对哌拉西林等16种抗菌药物耐药率呈逐步上升趋势(P<0.05)。至2014年7—12月,ICU鲍曼不动杆菌对17种抗菌药物的耐药率都在80%以上,其中对头孢哌酮耐药率最高,达100%。ICU鲍曼不动杆菌对17种抗菌药物的耐药率均高于全院的鲍曼不动杆菌的耐药率(P<0.05)。结论:鲍曼不动杆菌耐药率情况严峻,预防医院感染和合理使用抗菌药物的措施显得更为重要,否则持续的耐药率升高将使临床治疗多重耐药鲍曼不动杆菌面临无药可选的局面。

Objective： o investigate the distribution of Acinetobacter baumannii in an intensive care unit（ ICU） and its resistance to common antibiotics. Methods： Samples of clinically isolated pathogens from ICU of Second Affiliated Hospital of Guangzhou Medical University between 2012 and 2014 were collected. We reviewed the characteristics of species distribution and sample sources,and analyzed the changing rate of drug resistance of Acinetobacter baumannii in our ICU with comparison with overall drug resistance rate of Acinetobacter baumannii in our hospital. Results： Of the 1322 bacteria strains detected from ICU,Acinetobacter baumannii strains ranked first in number（ 751,56.81%）,with 617 strains（ 82.16%） isolated from sputum or bronchial aspirates. Between2012 and 2014,the ICU-isolated Acinetobacter baumannii strains showed steadily increasing resistance to piperacillin and other 16 kinds of antibitics（ P0.05）. Up to the second half of 2014,the drug resistance rates of Acinetobacter baumannii to the 17 kinds of antibiotics were above 80%; in particular,the resistant rate to cefoperazone was the highest of all,up to 100%. The resistance rates of ICU-isolated Acinetobacter baumannii to the 17 kinds of antibiotics were higher than the overall resistance rates of those isolated in our hospital（ P0.05）.Conclusion： The drug resistance rate of Acinetobacter baumannii appears arduous. Measures to prevent nosocomial infections and promote rational use of antibiotics should be observed; otherwise,given persistently increasing trend of drug resistance,there would be no antibiotics available to combat multi-drug resistant Acinetobacter baumannii in the future.