鲍曼不动杆菌临床分布、耐药性变迁及预防对策

Clinical distribution,drug resistance changes and preventive measures of Acinetobacter Baumanii

目的调查2011—2016年临床标本分离的鲍曼不动杆菌(Acinetobacter baumannii,Ab)的临床分布、耐药性变迁、血流感染危险因素,为合理应用抗菌药及预防感染提供依据。方法分析2011—2016年间本院鲍曼不动杆菌标本来源、病区分布及耐药率和耐药性变迁,以及导致Ab血流感染患者死亡的危险因素。结果共2110例标本,主要为痰培养1840例(87.2%),其次为血培养、引流液培养。临床分布中重症医学科(intensive care unit,ICU)占比最高(52.6%),其次为干部病房(9.8%)、胸外科(7.0%)。药敏提示近6年CZO、FOX的耐药率最高,TGC的最低。2011—2012年耐药率最低为AMK;2013—2014年以及2015—2016年最低均为TGC。CSL的耐药性变化最大(24%~64%),TGC的变化最小(1.70%~11.40%)。Ab血流感染患者死亡率最高(46.43%)。深静脉置管(P=0.008)、APACHEⅡ≥20(P<0.001)为影响血培养阳性患者死亡的独立危险因素。结论Ab耐药性逐年增加,本地医护人员应合理使用抗菌药物,以预防及控制Ab的流行及多重耐药菌株的产生。

Objective To investigate the clinical distribution,drug resistance,risk factors of blood stream infection of Acinetobacter baumannii(Ab)isolated from clinical specimens from 2011 to 2016,in order to provide basis for rational application of antibacterial drugs and prevention of infection.Methods To analyze the source of Acinetobacter baumannii specimens,distribution of disease area,the rate of drug resistance,the change of drug resistance and the risk factors of death in patients with Ab blood flow infection in Anhui Provincial Hospital from 2011 to 2016.Results Of the 2110 specimens,1840(87.2%)were sputum cultured,followed by blood cultured and drainage cultured.In the clinical distribution,intensive care unit(ICU)contributed the highest proportion which was 52.6%,followed by 9.8% of cadre ward and 7.0% of thoracic surgery.Drug susceptibility test indicated that the drug resistance rates of CZO and FOX were the highest in recent 6 years,and that of TGC was the lowest.The lowest rate of drug resistance was AMK during 2011 and 2012.Both in 2013-2014 and 2015-2016,the lowest rate of drug resistance was TGC.The change of drug resistance of CSL was the greatest(24-64%),and that of TGC was the smallest(1.70-11.40%).The mortality rate of AB bloodstream infection was the highest(46.43%).Deep venous catheterization(P=0.008)and APACHEⅡ over 20(P<0.001)were independent risk factors for death in patients with positive blood culture.Conclusions Ab resistance is increasing year by year.Local medical staffs should use antibiotics rationally in order to prevent and control the prevalence of Ab and the emergence of multi-drug resistant strains.