2011～2015年医院鲍曼不动杆菌药敏变化分析

Trend Analysis of Drug-resistance of Acinetobacter baumannii Clinically Isolated from 2011 to 2015

目的:了解医院分离鲍曼不动杆菌(Ab)的药敏变化,为临床经验性治疗提供参考。方法:回顾性分析山东省立医院2011~2015年Ab药敏变化趋势及不同部位菌株药敏情况。结果:2011~2015年共分离非重复Ab 1 355株,主要分布于痰、皮肤软组织、导管、尿、脑脊液等5个不同部位,分离自非ICU住院患者的菌株占67.23%;亚胺培南耐药株占53.50%,所有菌株对多黏菌素及替加环素的敏感率均>90%,其他药物敏感率均<70%。2012年比2011年、2013年比2012年菌株对14种抗菌药物中的11种敏感性显著升高(P<0.05);但2014年比2013年药敏变化不明显,2015年比2014年对各药物的敏感性显著下降(P<0.05);不同部位Ab对抗菌药物的敏感性略有差异;除多黏菌素及替加环素,碳青霉烯耐药鲍曼不动杆菌对各种药物敏感率均<30%。结论:Ab可能存在传播,应加强院内感染控制;Ab大多为多重耐药菌,临床治疗可选药物有限,应监测药敏变化或根据药敏结果合理选择抗菌药物。

Objective： Understanding the trend of drug-resistance of Acinetobacter baumannii to provide the basis of experiential therapy for clinic. Methods： Retrospective analysis was used for Acinetobacter baumannii isolated during 2011 to 2015 in Shandong provincial hospital. The change trend of the drug susceptibility and the drug susceptibility of isolates from different parts. Results： From 2011 to 2015,a total 1355 strains Acinetobacter baumannii were isolated,mainly distributed in sputum,skin and soft tissues,catheter,urine and cerebrospinal fluid. Non-ICU isolates were 67. 23%. Imipenem resistant Acinetobacter baumannii was 53. 5%,and the antibiotic sensitive rates to tigecycline and polymyxin were higher,which more than 90%. The antibiotic sensitive rates to other antibiotic were less than 70%. During 14 antibacterial agents,there were 11 drug susceptibility elevated significantly,when compared 2012 with 2011,2013 with 2012. However,the drug susceptibility results did not change significantly when compared 2014 with 2013,and the drug susceptibility results decreased significantly when compared 2015 with 2014. The strains from different parts showed different drug susceptibility. For carbapenem-resistance Acinetobacter baumanniihe sensitive rates of all antibiotic but tigecycline and polymyxin were less than 30%,which ignificantly lower than the arbapenem-sensitive Acinetobacter baumannii. Conclusion：The infection of Acinetobacter baumannii may spread and we should prevent and control the infection in hospital. Most of Acinetobacter baumannii were isolated from clinic. It is very limited to choice in the clinical treatment. Clinicians should carefully choose antibiotics according to the results of the drug-susceptibility.