2014-2016年某医院耐碳青霉烯类鲍曼不动杆菌的临床分布和耐药性分析

Analysis of clinical distribution and drug resistance of carbapene-resistant Acinetobacter baumannii in a hospital between 2014 and 2016

目的了解耐碳青霉烯类鲍曼不动杆菌(CRAB)的临床分布和耐药性变化。方法收集2014年1月-2016年12月住院患者的CRAB菌株数据,描述其临床分布,并用WHONET软件进行耐药性分析。结果 1 182株非重复分离的鲍曼不动杆菌中,检出CRAB 514株,其中CRAB感染菌株367株; 2014-2016年CRAB感染检出率逐年上升; CRAB标本多来源为痰液,占61. 31%; CRAB感染部位主要集中在下呼吸道,占47. 1%; CRAB感染菌株主要分布在神经外科、胸外科、急诊科、普外科胃肠和呼吸科,占59. 67%; 3年间CRAB对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和复方新诺明的耐药率呈逐年下降趋势。结论 CRAB感染主要发生在神经外科和胸外科等科室的下呼吸道感染病例中,CRAB对抗菌药物的耐药率均较高,采取合理的抗菌药物管理措施可降低其耐药性。

Objective To describe the clinical distribution and the drug resistance of Carbapene-resistant Acinetobacter Baumannii（ CRAB）. Methods During January 2014-December 2016,we collected CRAB data of clinical specimens among hospitalized patients,described the clinical distribution and analyzed it with WHONET software. Results There were1182 strains of Acinetobacter Baumannii in all. 514 strains were CRAB,among which 367 strains were infected strains. During the three years,the proportion of CRAB infected strains among all the Acinetobacter Baumannii grew up significantly each year（ χ2= 20. 647,P 0. 001）; the sputum accounted for 61. 31%,which was the most in all the clinical samples; the infection site focused on the low respiratory tract,which accounted for 47. 1%; 59. 67% of the infected CRAB strains came from Department of Neurosurgery,thoracic surgery,emergency department,Gastroenterological Surgery and department of Respiration. The drug resistant rates of Piperacillin/tazobactam,Cefoperazone/sulbactam and compound sulfamethoxazole were highest in 2014 and went down each year significantly. Conclusion Most of the CRAB infection happen in the low respiratory tractost of the patients from epartment of Neurosurgery,thoracic surgery,and so on. The drug-resistant rates of bacteria high for CRAB. Rational management measures can help reduce the rate.