危重症患者560株鲍曼不动杆菌的临床分布及药敏结果

The clinical distribution and drug resistance of 560 strains of Acinetobacter baumannii in critically ill patients

目的了解ICU患者鲍曼不动杆菌的检出率、分布及耐药状况,为临床ICU患者合理用药提供参考。方法对四川省人民医院急诊ICU、老年ICU、呼吸ICU、神经内科ICU、外科ICU送检的各类临床标本中分离的鲍曼不动杆菌进行系统分析。应用VITEK-2全自动细菌鉴定药敏仪并参照2013年美国临床实验室标准化委员会(CLISI)标准判断药敏结果,以WHONET5. 6及GRAPHPAD6. 0统计软件进行数据分析。结果 5年间5个ICU共检出560株鲍曼不动杆菌;鲍曼不动杆菌的检出率为急诊ICU36. 8%、老年ICU 20. 4%、呼吸ICU 12. 1%、神经内科ICU 8. 0%、外科ICU 22. 7%;痰液鲍曼不动杆菌检出率为70. 9%,血液12. 1%、其他17. 0%;抗菌药物敏感试验共检出耐碳青霉烯类鲍曼不动杆菌(CRAB) 236株,占42. 1%;老年ICU的耐碳青霉烯类鲍曼不动杆菌(CRAB)检出率为57. 9%,高于其他科室(P <0. 05)。共检出泛耐药鲍曼不动杆菌(XDRAB) 64株,占11. 4%,各科室标本中XDRAB检出率差异无统计学意义(P> 0. 05);对头孢他啶耐药率为40. 7%,头孢哌酮/舒巴坦耐药率为45. 0%,哌拉西林/他唑巴坦30. 5%,左旋氧氟沙星的耐药率为30. 1%,对替加环素耐药率为16. 8%。结论不同重症监护室因病人来源不同,其鲍曼不动杆菌检出率有明显差别,耐药率亦有较大差异。

Objective To investigate the detection rate,clinical distribution and drug resistance of Acinetobacter baumannii( Ab) in ICU patients in order to provide the basis for rational use antimicrobial drugs.Methods Ab strains were isolated from various clinical samples at 5 main ICU departments in the Sichuan Provincial People’s Hospital and subjected to system analysis.VITEK-2 automatic bacteria identification system was used for bacteria identification and drug sensitivity,and the results of antimicrobial susceptibility were determined according to CLIS 2013 criteria.All the data were analyzed by WHONET 5. 6 and GRAPHPAD 6. 0.Results During the 5 years period,560 strains of Ab were detected.Among them,the detection rate in emergency intensive care unit was36. 8%,20. 4% in geriatric ICU,12. 1% in respiratory ICU,22. 7% in surgery ICU and 8. 0% in neurology ICU.The detection rate was70. 9% in sputum,12. 1% in blood sample and 17. 0% in other samples.There were 236 strains of CRAB detected by antimicrobial sensitivity test,accounting for 42. 1%.The detection rate of CRAB stains was 57. 9% in geriatrics ICU,which was higher than that in other ICUs( P < 0. 05).There were 64 strains of XDRAB were detected,accounting for 11. 4% but there was no significant difference among the departments and specimen types.The resistance rates of Ab to second generation ceftazibime was 40. 7%,to ampicillin sodium/ulbactam sodium was 45. 0%,to piperacillin sodium/tazobactam sodium were 30. 5% and to tolevo-ofloxaci was 30. 1%.The lowest resistance rate to Ab was tigecycline( 16. 8%).Conclusion The detection rate and resistance of Ab are different among departments.Clinicians should use antimicrobial drugs rationally.