2011-2015年鲍曼不动杆菌感染特征及耐药性变迁

Changes of antimicrobial agents resistance and distribution feature of Acinetobacter baumannii isolated from 2011 to 2015

目的探讨鲍曼不动杆菌的感染情况及耐药变化,为控制院内感染及指导临床合理使用抗生素提供实验依据。方法采用WHONET5.4统计软件回顾性分析2011-2015年临床分离的634株鲍曼不动杆菌的菌株来源、科室分布;应用SPSS17.0软件对细菌的耐药率进行分析;利用脉冲场凝胶电泳方法进行分子分型,分析耐药情况与脉冲场凝胶电泳分子结果之间的相关性。结果 634株鲍曼不动杆菌主要来自痰标本共353株(55.68%),检出率较高的科室为外科212株(33.44%)。5年间鲍曼不动杆菌对各类抗生素的耐药率逐年升高,耐药率变化最大的是头孢曲松,较敏感的药为亚胺培南。对所有抗生素全敏感的菌株带型数为10~13条,对所有抗生素全耐药菌株带型数为19条带型。脉冲场凝胶电泳方法分子分型提示,相同的分子分型菌株药敏试验结果相近。结论该院分离出的鲍曼不动杆菌的耐药率逐年上升,部分抗生素耐药较严重,临床医生应根据药敏结果和患者个人情况合理规范使用抗生素,避免多重耐药及泛耐药鲍曼不动杆菌菌株的产生。

Objective To investigate the Acinetobacter baumannii infection and drug resistance change, and provide the laboratory evidence for nosocomial infection control and clinical rational use of antibiotics. Methods WHONETS.4 statistical software were used of retrospective analysis of strain source and department distribution. The resistance rate of bacteria was analyzed by SPSS 17.0 software. Pulsed-field Gel Electrophoresis Method was performed for molecular typing. Drug resistance compared and Pulsed-field Gel Electrophoresis Typing results were compared by using statistical methods. Results 353 strains of Acinetobacter baumannii mainly from 634 sputum samples （55.68%）. The higher detection rate of Acinetobacter baumannii was in surgical department, 33.44% （212 strains）. Acinetobacter baumannii resistant rates of various types of antibiotics increased year by year in 5 years. The most common change in drug resistance rate was ceftriaxone; the more sensitive drug was imipenem. Strains that were sensitive to all antibiotics showed 10 to 13 bands in molecular typing, and the strains resistant to all antibiotics showed 19 bands. Molecular typing of pulsed- field gel electrophoresis suggests that the same molecular typing strains had similar drug susceptibility test results. Conclusion The drug resistance rate of Acinetobacter baumannii isolated from this hospital had increased year by year, and some strains were more resistant to antibiotics. Clinicians should rationally choose antibiotics based on drug susceptibility results and individual patient conditions to avoid multi-drug resistance and pan-drug resistance.