某院2011～2015年鲍曼不动杆菌感染分布及耐药性变迁

Distribution and changes of drug resistance of Acinetobacter Baumannii infection from 2011 to 2015

目的回顾分析某院2011~2015年分离鲍曼不动杆菌感染临床分布及耐药性变迁,为临床经验治疗鲍曼不动杆菌感染提供数据支持。方法使用Microscan Walkaway 40plus型全自动微生物鉴定及药敏分析仪对临床分离株进行鉴定及抗菌药物最低抑菌浓度检测,采用WHONET 5.6版软件对数据进行统计分析。结果 2011~2015年分别分离到鲍曼不动杆菌190株、269株、350株、336株、427株,分别检出碳青霉烯耐药鲍曼不动杆菌159株、222株、294株、281株、356株。鲍曼不动杆菌主要来源于ICU（559株,35.6%）、神经外科（276株,17.6%）、呼吸内科（271株,17.2%）等科室,主要分离自痰液（1 201株,76.4%）、伤口切口分泌物（124株,7.9%）、尿液（81株,5.2%）等标本。鲍曼不动杆菌对青霉素类、青霉素类/β内酰胺酶抑制剂复合物、头孢菌素类、碳青霉烯类、氨基糖苷类、喹诺酮类、四环素类耐药率均超过了80%。碳青霉烯耐药鲍曼不动杆菌对检测的所有抗菌药物耐药率高于总耐药率,对青霉素类、青霉素类/β内酰胺酶抑制剂复合物、头孢菌素类、碳青霉烯类、氨基糖苷类、喹诺酮类、四环素类耐药率均超过了95%。结论鲍曼不动杆菌耐药形势严峻,临床科室应根据微生物培养报告合理选择抗菌药物,同时应加强院内感染控制工作,避免碳青霉烯耐药鲍曼不动杆菌暴发流行。

Objective To investigate the clinical distribution and drug resistance of Acinetobacter Baumannii and to provide evidence of rational drug use for the treatment of Acinetobacter Baumannii infections.Methods The strains and the minimum inhibitory concentration were identified by using Microscan Walkaway 40 plus.The data were analyzed by the software of WHONET 5.6.Results From 2011 to 2015,totally 190,269,350,336 and 427strains of Acinetobacter Baumannii were isolated respectively and159,222,294,281 and 356strains of carbapenem resistant Acinetobacter Baumannii were isolated respectively.Patients who were infected by Acinetobacter Baumannii were mainly distributed in intensive care unit（559strains,which accounted for 35.6%）,neurosurgery（276strains,which accounted for 17.6%）,and respiratory medicine（271strains,which accounted for 17.2%）.There were 1 201,124 and 81strains which were mainly isolated form sputum（76.4%）,wound incision secretions（7.9%）and urine（5.2%）.Drug resistance rates of Acinetobacter Baumannii to penicillins,penicillin class/β-lactamase inhibitor combinations,cephalosporins,carbapenems,aminoglycosides,quinolones and tetracyclines were all higher than 80%.Drug resistance rates of carbapenem resistant Acinetobacter Baumannii to penicillins,penicillin class/β-lactamase inhibitor combinations,cephalosporins,carbapenems,some aminoglycosides,quinolones and tetracyclines were all higher than 95%,which were also higher than the total drug resistance rates.Conclusion The condition of drug resistance of Acinetobacter Baumannii is serious.Clinical departments should choose antibiotics reasonably according to microbiological culture report and should strengthen the hospital infection control to avoid outbreak of carbapenem resistant Acinetobacter Baumannii.