耐碳青霉烯类鲍曼不动杆菌目标性监测

Targeted surveillance on carbapenem-resistant Acinetobacter baumannii

目的了解耐碳青霉烯类鲍曼不动杆菌(CRAB)的临床分布和耐药特征。方法回顾性分析某院2015年1—12月所有住院患者送检标本CRAB检出情况,分析其药敏试验结果。结果 721株AB中检出CRAB231株,CRAB检出率为32.04%。1—4季度中每季度CRAB的检出率分别为48.99%(73/149)、41.98%(68/162)、27.39%(63/230)、15.00%(27/180),呈下降趋势(P<0.001)。CRAB主要来源于痰标本(140株,60.61%),其次是创面分泌物(33株,14.28%)和尿标本(24株,10.39%)。CRAB主要来源科室为重症监护病房(101株,43.72%)、神经外科(37株,16.02%)及烧伤整形科(22株,9.52%)。CRAB对氨苄西林/舒巴坦、庆大霉素、左氧氟沙星、环丙沙星的耐药率为85.28%~90.48%,对妥布霉素的耐药率较低(19.48%),未发现对多粘菌素B耐药的菌株。结论 CRAB耐药性较为严重,应针对重点科室进行重点管理,采取科学防控举措,有效减少医院感染事件的发生。

ObjectiveTo investigate the clinical distribution and antimicrobial resistance characteristics of carbapenemresistant Acinetobacter baumannii （CRAB）. MethodsCRAB isolated from all inpatients in a hospital in JanuaryDecember 2015 were performed retrospective analysis, antimicrobial susceptibility testing result was analyzed.ResultsA total of 721 AB strains were detected, 231 （32.04%） of which were CRAB, isolation rates of CRAB in quarter 1-4 were 48.99% （73/149）, 41.98%（68/162）, 27.39%（63/230）, and 15.00%（27/180）respectively, which showed a decreased trend （P〈0.001）. CRAB mainly came from sputum specimen（n=140, 60.61%）, followed by secretion of wound（n=33, 14.28%）and urine specimen（n=24,10.39%）. CRAB mainly distributed in intensive care unit, accounting for 43.72%（n=101）, following by department of neurosurgery（n=37, 16.02%） , and burn/plastic surgery （n=22, 9.52%）. Resistance rates of CRAB to ampicillin/sulbactam, gentamicin, levofloxacin, and ciprofloxacin were 85.28%-90.48%,resistance rate to tobramycin was low （19.48%）,no strains were found to be resistant to polymyxin B. ConclusionAntimicrobial resistance of CRAB is serious, it is necessary to focus on management of key departments, take scientific prevention and control measures, so as to effectively reduce the incidence of healthcareassociated infection.