鲍曼不动杆菌感染病原菌院内分布及耐药性:一个区域医疗中心2014—2016年的数据分析

Analysis on clinical distribution of Acinetobacter baumannii infection and its pathogenic drug resistance:a regional medical center from 2014 to 2016 years

目的了解鲍曼不动杆菌(ABA)的临床分布特征及其对常用抗菌药物的耐药性,为临床合理用药提供依据。方法采用法国生物梅里埃VITEK 2 Compact全自动微生物分析仪,对2014—2016年在四川省宜宾市第二人民医院住院患者的细菌培养中所分离的734株ABA菌株进行鉴定,并进行药敏试验。结果检出的734株ABA中,2014年284株,2015年229株,2016年221株;临床标本以痰液为主,占82.5%(605/734);菌株分布的临床科室以重症加强治疗病房(ICU)为主,占39.0%(286/734)。药敏试验结果显示,2014—2016年ABA对左氧氟沙星、哌拉西林/他唑巴坦、复方新诺明、亚胺培南、氨苄西林/舒巴坦的耐药率总体呈上升趋势[对左氧氟沙星耐药分别为60.6%(172/284)、64.2%(147/229)、71.9%(159/221);对哌拉西林/他唑巴坦耐药分别为59.2%(168/284)、61.1%(140/229)、74.2%(164/221);对复方新诺明耐药分别为30.3%(86/284)、34.5%(79/229)、57.0%(126/221);对亚胺培南耐药分别为27.8%(79/284)、18.3%(42/229)、52.9%(117/221);对氨苄西林/舒巴坦耐药分别为23.9%(68/284)、21.8%(50/229)、58.4%(129/221);均P<0.05],且ICU病区分离株的总体耐药率明显高于非ICU病区分离株,相比较差异均有统计学意义(均P<0.05)。结论我院ABA主要分离自痰液,临床分布以ICU为主;近年来ABA感染及耐药性有上升趋势,在耐药性监测中显示了多重耐药性,需引起临床关注,采取一系列有效措施控制其传播。

Objective To understand the clinical distributive characteristics of Acinetobacter baumannii（ABA） and its resistance to common antibiotics, so as to provide a base with reasonable application of drugs clinically. Methods The French bio Mérieux VITEK Compact 2 full automatic bacterial analyzer was used to identify the bacterial ABA strains that were isolated from the bacterial cultures of patients hospitalized in Yibin Second People＇s Hospital of Sichuan from 2014 to 2016, and the drug sensitivity tests were carried out. Results Within 734 ABA strains, there were 284 strains in 2014, 229 strains in 2015 and 221 strains in 2016. Sputum samples were the main clinical specimens, accounting for 82.4%（605/734）. Intensive Care Unit（ICU） was the most common place where ABA strains were found, accounting for 39%（286/734）. The results of antimicrobial susceptibility test showed that from 2014 to 2016, the resistance rates of ABA to levofloxacin, piperacillin/tazobactam, compound sulfamethoxazole, imipenem and ampicillin/sulbactam showed an overall upward trend [levofloxacin： 60.6%（172/284）、64.2%（147/229）、71.9%（159/221）, piperacillin/tazobactam： 59.2%（168/284）、61.1%（140/229）、74.2%（164/221）, compound sulfamethoxazole： 30.3%（86/284）、34.5%（79/229）、57.0%（126/221）, imipenem： 27.8%（79/284）、18.3%（42/229）、52.9%（117/221）, ampicillin/sulbactam： 23.9%（68/284）、21.8%（50/229）、58.4%（129/221）, all P〈 0.05]. The overall drug resistance rate from ICU isolates was significantly higher than that from non-ICU isolates, and the difference was statistically significant（P 〈0.05）. Conclusion In this hospital, the ABA strains were mainly isolated from the sputum specimens, and its clinical distribution is primarily in ICU. In recent years, the ABA infection and its drug resistance rates have a tendency of rise, and the drug sensitivity tests showed multi-drug resistance, which should arouse clinical attention and take a series of effective measures to control its transmission.