我院耐碳青霉烯类鲍曼不动杆菌和铜绿假单胞菌临床分布及耐药分析

Distribution and drug resistance analysis of carbapenem-resistant acinetobacter baumannii and psedomonas aeruginosa in Navy General Hospital

目的探讨我院2014年1月-2015年8月耐碳青霉烯类铜绿假单胞菌(psedomonas aeruginosa,PAE)和鲍曼不动杆菌(acinetobacter baumannii,ABA)临床分布及耐药情况,指导临床合理使用抗生素。方法对2014-2015年临床标本分离出的耐碳青霉烯类鲍曼不动杆菌(CR-ABA)和耐碳青霉烯类铜绿假单胞菌(CR-PAE)的分布情况及相关药敏结果进行回顾性分析。结果 2014-2015年分离耐碳青霉烯类PAE和ABA分别为156株和517株,两者>50.0%来源于呼吸道标本,34.0%的CR-PAE和15.5%的CR-ABA来自于高压氧科,其次为呼吸内科和ICU;两者耐药情况随患者年龄增长日趋严重。CR-PAE仅对阿米卡星一种抗生素耐药率在30%以下;CR-ABA除阿米卡星耐药率为21.3%,其他大部分抗菌药物耐药率均高达90.0%左右,美罗培南和亚胺培南耐药率分别为60.7%和90.1%。CR-PAE和CR-ABA对亚胺培南和美罗培南的耐药性显著高于非耐碳青霉烯类铜绿假单胞菌(非CR-PAE)和非耐碳青霉烯类鲍曼不动杆菌(非CR-ABA)(P<0.05)。结论耐碳霉烯类PAE和ABA的耐药率在不断上升,特别是泛耐药菌株和多重耐药菌株。

Objective To investigate the distribution and drug resistance of carbapenem-resistant psedomonas aeruginosa（PAE） and acinetobacter baumannii（ABA） in our hospital from January 2014 to August 2015 and promote clinical rational use of antibiotic. Methods The distribution and drug resistance of the carbapenem-resistant acinetobacter baumannii（CR-ABA） and carbapenemresistant psedomonas aeruginosa（CR-PAE） isolated from clinical samples in our hospital from 2014 to 2015 were retrospectively analyzed. Results From 2014 to 2015, 156 and 517 strains of CR-PAE and CR-ABA were separated, and more than 50.0% samples were from phlegm. And 34.0% of CR-PAE and 15.5% of CR-ABA were isolated from department of hyperbaric oxygen, followed by respiratory medicine and ICU. The drug resistance became more serious as patients＇ age growing. Only resistance of CR-PAE to amikacin was under 30%; Except resistance of CR-ABA to Amikacin was 21.3%, resistances to other antibiotics were higher than 90.0%, and the resistances to meropenem and imipenem were 60.7% and 90.1%, respectively. Compared with PAE and ABA, resistance of CR-PAE and CR-ABA to imipenem and meropenem were significant different（P〈0.05）. Conclusion Resistance of CR-PAE and CR-ABA has increased, especially in multi-drug resistance and pan-resistant strains.