我院2015～2017年耐碳青霉烯类鲍曼不动杆菌的临床分布及耐药监测

Clinical distribution and drug resistance monitoring of Carbapenemase-resistant Acinetobacter baumannii in our hospital from 2015 to 2017

目的了解临床分离耐碳青霉烯类鲍曼不动杆菌(CRAB)的分布及耐药情况。方法收集2015年1月~2017年12月自内蒙古自治区中医医院临床共分离的359株鲍曼不动杆菌,其中CRAB147株。采用纸片扩散法进行药敏试验,试验结果按照美国临床和实验室标准协会(CLSI)2016年版标准判读,采用WHONET5.6软件进行耐药性分析,SPSS20.0软件进行统计分析。结果3年内CRAB总检出率为40.95%,2016年(43.90%)与2017年(48.51%)的CRAB检出率均显著高于2015年(27.45%),差异有统计学意义(P<0.05);2016年与2017年的CRAB检出率比较,差异无统计学意义(P>0.05)。CRAB的标本来源主要为痰标本,科室以重症监护病房(ICU)为主。CRAB对米诺环素的耐药率最低(15.65%),对其他抗菌药物的耐药率为80.95%~100.00%;CRAB与碳青霉烯类药物敏感的鲍曼不动杆菌(CSAB)的耐药率比较,除米诺环素外(P>0.05),CRAB对所检测的其他抗菌药物的耐药率均高于CSAB,差异有统计学意义(P<0.05)。结论近3年内蒙古自治区中医医院CRAB检出率增高,且耐药性现象严重。该院应重视CRAB感染的预防和控制,尤其是ICU科室,并且可尝试使用米诺环素进行CRAB的临床治疗。

Objective To understand the distribution and drug resistance of clinical isolates of Carbapenemase-resistant Acinetobacter baumannii (CRAB). Methods A total of 359 Acinetobacter baumannii (AB) strains which were isolated from clinic in Traditional Chinese Medicine Hospital of Inner Mongolia Autonomous Region from January 2015 to December 2017 were collected, among which 147 stains were CRAB. The drug sensitivity test was carried out by the by kirby-bauer method. The test results were interpreted according to the American Clinical and Laboratory Standards Association (CLSI)(2016 edition standard). The WHONET 5.6 software was used for drug resistance analysis, and the SPSS 20.0 software was used for statistical analysis. Results The total detection rate of CRAB in 3 years was 40.95%. The CRAB detection rate in 2016 (43.90%) and 2017 (48.51%) was significantly higher than that in 2015 (27.45%), and the differences were statistically significant (P<0.05). There was no significant difference in the CRAB detection rate between 2016 and 2017 (P>0.05). The source of CRAB specimens was mainly isolated from sputum, and the department was mainly in intensive care unit (ICU). CRAB had the lowest resistance rate to Minocycline (15.65%), and the resistance rate to other antibacterial agents was 80.95%-100.00%. The drug resistance rate of CRAB to other antibacterial agents was significantly higher than that of Carbapenem-sensitive Acinetobacter baumannii (CSAB), and the difference was statistically significant (P<0.05), except to Minocycline (P>0.05). Conclusion In the past 3 years, the detection rate of CRAB in the Traditional Chinese Medicine Hospital of Inner Mongolian Autonomous Region has increased, and the drug resistance phenomenon is serious. The hospital should pay more attention to the prevention and control of CRAB infection, especially in ICU, and Minocycline can be tried for clinical treatment of CRAB.