庆阳地区耐碳青霉烯类鲍曼不动杆菌耐药性及表型分析

Drug resistance and phenotypeto study of carbapenems-resistant Acinetobacter baumannii in Qingyang

目的分析庆阳地区耐碳青霉烯类抗生素鲍曼不动杆菌(CRAB)的分布特点及耐药情况,检测耐药表型,指导临床用药。方法常规培养分离细菌,应用VITEK 2 Compact全自动细菌分析仪鉴定细菌;用GN-AST09和K-B法检测细菌耐药性;通过改良Hodge试验和EDTA协同试验对碳青霉烯酶进行表型检测。结果 110株CRAB主要分离自痰液标本(70%),其次为肺泡灌洗液和伤口分泌物;科室分布以ICU比率最高(56%),其次为神经外科(20%),呼吸内科(9%)。在检测的12种药物中,对丁胺卡那、复方新诺明、左氧氟沙星敏感性较低,分别为33%、33%和7%,对其他抗生素耐药率均为100%;改良Hodge实验除1株为阴性外其他均为阳性;EDTA协同法实验均为阳性。结论 CRAB具有广泛的耐药性,应加强CRAB的耐药监测,建立有效的感染控制措施并合理应用抗菌药物,防止CRAB的流行。

Objective To investigate the distribution characteristics and drug resistance of carbapenems - resistant acinetobacter baumannii（CRAB） in Qingyang, test the drug resistance phenotypeto and guide clinic for rational antimicrobical use. Methods All strains were isolated and identified by routine procedure and ~ITEK 2 Compact automatic bacterial identification instrument. Drug susceptibility test was performed with GN - AST09 and K - B paper method. The phenotype test was performed by modified Hodge test and EDTA - disk synergy test. Results 110 strains were mainly isolated from sputum, and followed by bronchoalve- olar lavage fluid and secretions. The specimen mostly distributed in ICU with the highest rate of 56%, followed by neurosurgery department（20% ） and respiratory（70% ） medicine department（9% ）. The sensibility was low for amikacin（33% ）, selectrin （33%）, levofloxacin（7% ）, and the resistant rate to other antibiotics was all 100% in 12 drugs. All strains but one showed positive results of Hodge test. All tested were positive of EDTA - disk synergy test. Conclusion There is widespread resistance to CRAB, and drug resistance surveillance of CRAB should be strengthened. Effective infection control measures and antimicrobial intervention policy should be taken to prevent the outbreak of CRAB.