我国不同地区三甲医院患者鲍曼不动杆菌的分布及耐药性比较

Comparison of distribution and drug resistance of acinetobacter baumanii in tertiary hospitals in different regions

目的总结东南、西北、中南、东北、华北以及华东地区2014年6月—2015年6月9个大型三甲医院鲍曼不动杆菌的分布及其耐药性,为临床合理用药提供依据。方法收集2014年6月—2015年6月入院且发生鲍曼不动杆菌感染的患者,对其痰、分泌物、血液等进行分离培养。药敏实验方法按CLSI规定的标准进行,并采用WHONET 5.6软件进行计数、SPSS 20.0软件进行统计分析。结果各地区住院患者共分离1 950株鲍曼不动杆菌,主要来自于中心ICU(16.63±4.36)%、神经外科(15.97±4.28)%、普通外科(14.29±2.01)%和心血管内科(17.92±2.66)%。样本来源主要是痰(72.84±3.52)%,其次还主要来源于尿液(7.38±1.53)%和胸/腹水(5.65±1.89)%。鲍曼不动杆菌对本实验中各种抗菌药物的耐药率均>60%。结论鲍曼不动杆菌在心血管内科和中心ICU最多,可能是由于病人抵抗力虚弱造成的。就当前来看,鲍曼不动杆菌对目前常用的抗菌药物普遍耐药。因此,加强对鲍曼不动杆菌耐药性的检测,防止其播散流行,是最好的感染控制的方式。

Object ive To summar ize the dist r ibut ion and drug resistance of Acinetobacter baumannii in ter tiary hospitals in different regions of China and to provide evidence for rational use of drugs,control of hospital infections and for the development of new drugs.Methods Infected patients hospitalized between June2014and June2015were col lected before thei r sputum,blood and wound exudate were isolated and cultured.Drug resistance was also analyzed using the standards of CLSI and WHONET5.6while SPSS20.0software was used for statistical analysis.Results A total of1950strains of pathogenic bacteria were detected in the six regions,most of which were detected in central ICUs(16.63±4.36)%,depar tments of neurosurgery(15.97±4.28)%,depar tments of general surgery(14.29±2.01)%and depar tments of vasculocardiology(17.92±2.66)%.The samples mostly came from sputum(72.84±3.52)%,urine(7.38±1.53)%and hydrothorax/ascites(5.65±1.89)%.The resistant rate of Acinetobacter baumannii to the tested ant imicrobial drugs was general ly over60percent.Conclus ion Acinetobacter baumanni i mainly comes f rom vasculocardiology deparments and central ICUs,possibly because of the weak immunologic resistance of patients.Acinetobacter baumannii is widely resistant to antimicrobial drugs.Therefore,the best way to control Acinetobacter baumannii infections is to strengthen surveillance and to contain its spread.