中国西部地区多重耐药鲍曼不动杆菌的耐药及分布特点

The multidrug resistance of Acinetobacter baumannii in Western China and its distribution characteristics

目的探讨中国西部地区多重耐药鲍曼不动杆菌的分布和耐药情况,为预防和控制医院感染,合理使用抗生素提供依据。方法回顾性分析2016—2017年,中国西部地区10家三甲医院微生物实验室细菌培养中多重耐药鲍曼不动杆菌的分离情况、分布及耐药性特点;数据统计及药敏分析采用WHONET 5.6软件。结果 2016—2017年送检菌株共检出鲍曼不动杆菌8847株,检出率7.43%,其中多重耐药鲍曼不动杆菌5768株,检出率4.84%,占检出鲍曼不动杆菌的65.20%;多重耐药鲍曼不动杆菌主要分离自呼吸道标本(80.97%)、分泌物(6.12%)及血液(2.08%),科室分布以重症监护室(14.6%)、急诊科(11.94%)、呼吸科(11.62%)为主;在多重耐药鲍曼不动杆菌感染患者中,70岁以上的患者最多,共1688例(29.26%),明显多于其他年龄段;多重耐药鲍曼不动杆菌对12种常用抗菌药物的耐药性普遍较高,其中有7种大于90%,耐药率最低的是阿米卡星为55.7%,其次是妥布霉素与复方磺胺甲噁唑,分别为67.40%和68.25%。结论中国西部地区多重耐药鲍曼不动杆菌感染问题仍然十分严重,尤其是碳青霉烯类耐药菌,且分布及耐药性与其他地区相比具有一定的差异性;多重耐药鲍曼不动杆菌感染经验治疗可首先考虑选用阿米卡星,其次是复方磺胺甲噁唑和妥布霉素。各地区医院应加强监测,督促临床根据药敏结果合理使用抗生素,减少多重耐药鲍曼不动杆菌的产生,其次各医院实验室要进一步加强对多重耐药鲍曼不动杆菌的系统性分析研究,为临床及医院感染提供更加科学有效的实验室数据。

Objective To investigate the distribution and drug resistance of multidrug resistance of Acinetobacter baumannii in Western China, and provide evidence for the rational use of antibiotics and prevention and control of nosocomial infections. Methods We retrospectively analyzed the isolation, distribution, and drug resistance of multidrug-resistant Acinetobacter baumannii in the bacterial cultures of ten top-three hospitals in Western China from 2016 to 2017. WHONET 5.6 software was used in data analysis and drug susceptibility analysis. Results 8,847 strains ofAcinetobacter baumannii were detected in the tested strains from 2016 to 2017, and the detection rate was 7.43%. Among them, 5,768 strains ofAcinetobacter baumannii with multidrug resistance were detected, and the detection rate was 4.84%. 65.20% of strains of Bacillus were multi-drug resistant Acinetobacter baumannii which were mainly isolated from sputum specimens （80.97%）, secretions （6.12%）, and blood （2.08%）, and were distributed to the intensive care unit （14.6%）, the emergency department （11.94%）, and the department of respiratory diseases （11.62%）. Among the patients with multidrug-resistant Acinetobacter baumannii, the largest number of patients was over 70 years old, a total of 1,688 cases （29.26%）, which was significantly more than other age groups. The multi- drug resistance rates of Acinetobacter baumannii were generally higher than others to 12 commonly used antibiotics. The resistance rates to seven species were over 90%. The lowest resistance rate was 55.7%, which was to amikacin, followed by bumycin （67.40%） and compound sulfamethoxazole （68.25%）. Conclusion The multidrug resistance of Acinetobacter baumannii in Western China is still very serious. Particularly, carbapenem-resistant drug-resistant bacteria, and its distribution and drug resistance were significantly different compared with other regions. Amikacin should be firstly considered for the treatment of multidrug resistant Acinetobacter baumannii infections, followed by cotrimoxazole and tobramycin. All hospitals in this region should strengthen monitoring and supervising the clinical rational use of antibiotics based on the drug susceptibility in order to reduce the occurrence of multidrug resistant Acinetobacter baumannii. In addition, laboratories in hospitals should further strengthen analytical research of the multidrug resistant Acinetobacter baumannii to provide more scientific and effective laboratory data for clinics and hospitals.