耐碳青酶烯类鲍曼不动杆菌的检出和抗菌活性的分析

Analysis of the detection and antibacterial activity of the carbapenem resistant Acinetobacter baumannii

目的通过对耐碳青酶烯类鲍曼不动杆菌(carbapenem resistant Acinetobacter baumannii,CRAB)和碳青酶烯类敏感鲍曼不动杆菌(carbapenem sensitive Acinetobacter baumannii,CSAB)的分离结果和耐药性分析,指导临床合理用药。方法回顾性对比分析2015年1月—2017年6月分离出的729株CRAB和170株CSAB的标本来源、病区分布和耐药性。数据分析采用Whonet5.6统计软件,差异显著性分析使用IBM SPSS Statistics 20软件,耐药率比较采用χ2检验。结果 CRAB的分离率为81.09%。病区分布主要为ICU病房、神经内科、呼吸内科、神经外科和干部保健病房,构成比分别为35.53%、17.28%、14.54%、12.48%和10.43%。从ICU病房检出CSAB(6.47%)的构成比明显低于CRAB(35.53%),二者比较差异有显著性(P<0.05)。CRAB的标本来源主要为痰液,构成比为80.90%。CRAB耐药率较高,除对左氧氟沙星和复方磺胺甲噁唑的耐药率分别为36.76%和66.67%外,对其他10种抗菌药物的耐药率大于92.04%;而CSAB耐药率较低,对所有12种抗菌药物的耐药率小于15.88%。CSAB对12种抗菌药物的耐药率均低于CRAB,且差异有显著性(P<0.05)。CRAB对左氧氟沙星的中介的比率为60.08%;CSAB对头孢曲松的中介的比率为67.06%。结论 CRAB的分离率和耐药性较高,CRAB的耐药率明显高于CSAB,实验室应及时报告CRAB的分离和耐药性结果,做好细菌耐药监测工作。

Objective The separation results and drug resistance analysis of the carbapenem resistant Acinetobacter baumannii （CRAB） and the carbapenem sensitive Acinetobacter baumannii （CSAB） were analyzed to guide the clinical rational drug use. Methods A retrospective study was conducted to analyze the source, the distribution and the drug resistance of 729 CRAB strains and 170 CSAB strains isolated from January 2015 to June 2017. The data analysis used statistical software Whonet 5.6, the significance of difference analysis used the IBM SPSS Statistics 20 software, and the resistance rate was compared with the χ2 test. Results The separation rate of CRAB was 81.09%. The distribution of these strains in the disease wards were mainly ICU, neurology, respiratory medicine, neurosurgery, and cadres health care, which constituted 35.53%, 17.28%, 14.54%, 12.48% and 10.43%. The composition ratio of CSAB （6.47%） in ICU ward was significantly lower than that of CRAB （35.53%）, and the comparative differences were significant （P〈0.05）. The specimens of CRAB were mainly sputum, with a ratio of 80.90%. CRAB resistant rates were high, in addition to ofloxacin and cotrimoxazole with the resistant rates of 36.76% and 66.67% respectively, the resistant rates to other 10 kinds of antimicrobial drugs were more than 92.04%. However, the resistance rates of CSAB were low, and the drug resistance rate of all 12 antibacterial drugs were less than 15.88%. The resistance rates of CSAB to 12 antibacterial drugs were lower than those of CRAB, and the difference was significant （P〈0.05）. The intermediate rate of CRAB to ofloxacin was 60.08%, the intermediate rate of CSAB to ceftriaxone was 67.06%. Conclusion CRAB has a higher rate of separation and resistance, and the drug resistance rate of CRAB was significantly higher than that of CSAB. The laboratory should report the isolation and drug resistance of CRAB in a timely manner, and do a good job in the monitoring of bacterial resistance.