2015-2018年重庆市某三级甲等医院鲍曼不动杆菌的临床分布及耐药性分析

Analysis of Clinical Distribution and Drug Resistance of Acinetobacter baumannii in a Third-grade Class-A Hospital from Chongqing during 2015 to 2018

目的:为临床治疗鲍曼不动杆菌感染及合理使用抗菌药物提供参考依据。方法:采用回顾性分析方法,收集2015年1月-2018年12月我院住院患者分离出的64500株细菌,使用WHONET 5.6软件对其中鲍曼不动杆菌的检出率、标本类型、送检科室进行统计,采用R×C表χ2检验分析4年间鲍曼不动杆菌对18种临床常用抗菌药物的耐药率差异。结果:2015-2018年分别分离出鲍曼不动杆菌2072、2040、2017、2143株,分别占当年阳性标本的12.85%、13.38%、13.60%、11.71%;8272株鲍曼不动杆菌的标本类型主要包括痰液(4368株,占52.81%)、脓液(1106株,占13.37%)、腹水(804株,占9.72%);送检科室主要为烧伤科(1605株,19.40%)、肝胆科(1200株,14.51%)、脑外科(977株,11.81%);对18种抗菌药物的耐药率呈波浪形下降趋势(P<0.001),2018年数据显示,对氨苄西林、氨曲南的耐药率均大于80%,对氨苄西林/舒巴坦、头孢他啶、左氧氟沙星、复方磺胺甲噁唑、庆大霉素、阿米卡星、妥布霉素、替加环素的耐药率均小于50%,其中对阿米卡星和替加环素的耐药率分别为14.7%和0。结论:2015-2018年我院鲍曼不动杆菌的分离株数和检出率无明显变化;该菌主要引起呼吸道感染,建议使用阿米卡星或替加环素进行治疗。

OBJECTIVE:To provide reference for clinical treatment of Acinetobacter baumannii infection and rational use of antibiotics.METHODS:By retrospective analysis,64500 strains of bacteria were isolated from the inpatients of our hospital during Jan.2015 to Dec.2018.WHONET 5.6 software was used to analyze the detection rate,specimen type,departments of A.baumannii.The resistance of A.baumannii to 18 commonly used antibiotics in 4 years was analyzed by RxC tableχ2 test.RESULTS:A total of 2072,2040,2017 and 2143 strains of A.baumannii were isolated during 2015-2018,accounting for 12.85%,13.38%,13.60%,11.71%of positive specimens.The main specimen types of 8272 strains of A.baumannii were sputum(4368 strains,52.81%),pus(1106 strains,13.37%),ascites(804 strains,9.72%).The main departments were burn department(1605 strains,19.40%),hepatobiliary department(1200 strains,14.51%),brain surgery department(977 strains,11.81%).The drug resistance rate to 18 kinds of antibiotics showed a wave-like decreasing trend(P<0.001).In 2018,drug resistance rate to ampicillin and aztreonam was more than 80%,and that to ampicillin/sulbactam,ceftazidime,levofloxacin,Compound sulfamethoxazole,gentamicin,amikacin,tobramycin and tegacyclin was less than 50%,among which the drug resistance rate to amikacin and tegacyclin were 14.7%and 0,respectively.CONCLUSIONS:There is no significant change in the number of isolates and detection rate of A.baumannii in our hospital between 2015 and 2018.The bacteria mainly cause respiratory tract infection.Amikacin or tegacyclin are recommended for treatment.