某院2016—2020年鲍曼不动杆菌的临床分布及耐药性变迁

Clinical distribution and drug resistance of Acinetobacter baumannii in a hospital from 2016 to 2020

目的 分析鲍曼不动杆菌(AB)临床分布及耐药变迁,为临床控制院内感染及有针对性的经验治疗,合理使用抗菌药物提供参考。方法 回顾性分析2016年1月至2020年12月滨州某三甲医院住院和门诊患者分离AB及其临床资料,采用WHONET 5.6软件进行耐药分析。采用χ^(2)检验分析5年间鲍曼不动杆菌对16种临床常用抗菌药物的耐药率差异。结果 1365株AB标本主要分布在痰液和肺泡灌洗液;科室主要分布在重症医学科和神经外科。5年间AB在革兰氏阴性菌的检出率2020年下降,差异有统计学意义(P<0.05),耐碳青霉烯类鲍曼不动杆菌(CRAB)检出率呈现下降趋势(P<0.05)。5年间AB对除米诺环素和替加环素外的抗菌药物耐药率于2017年至最高峰然后呈下降趋势(P<0.05),对米诺环素耐药率呈逐年上升趋势(P<0.05)。替加环素耐药率无变化(P>0.05)。2020年AB对所有抗菌药物耐药率均低于30%;5年AB与CRAB除对替加环素耐药率无差异(P>0.05)外,CRAB对其它抗菌药物的耐药情况均高于AB(P<0.05)。结论 本院AB耐药性逐渐得到控制,2020年后临床抗AB抗菌药可供选择品种较多,医院抗菌药物专项整治活动降低了AB耐药率。加强抗菌药物管理对规范临床用药、减少耐药菌产生具有重要作用。

objective To analyze the the distribution and drug sensitivity of Acinetobacter baumannii(AB),and to provide a theoretical basis for effective prevention and control of infection and guidance of rational use of drugs in clinical practice.Methods With retrospective analysis,data of AB and clinical data were collected from the inpatients and outpatients of a tertiary hospital from Jan.2016 to Dec.2020.WHONET software was used to analyze the drug resistance.The Chi-test was used to analyze the different of the resistance rates of AB to 16 commonly used antibiotics during the 5 years.Results Totally 1365 strains of AB were mainly distributed in sputum and alveolar lavage fluid,and ICU and neurosurgery were the high-incidence departments of infection.The detection rate of AB in gram-negative bacteria decreased in 2020,and the difference was statistically significant(P<0.05).the detection rate of CRAB had decreased.The drug resistance rates of AB to antibiotics(excluding minocycline and tigecycline)peaked in 2017 and then showed a downward trend(P<0.05).The resistance rate of AB to minocycline increased year by year(P<0.05)and the resistance rate of AB to tigecycline remained stable(P>0.05).The rate of drug resistance to all antibiotics was less than 30%in 2020.There was no difference in drug resistance rate of AB and CRAB to tigecycline in 5 years(P>0.05),while CRAB showed higher resistance to other antibiotics(excluding tigecycline)than AB(P<0.05).Conclusion The drug resistance of AB in the Hospital is well controlled and a great variety of products are available for clinical use after 2020.The special rectification activity of antimicrobial agents has reduced the drug resistance rate of AB.It is important to strengthen the management of antibiotics for standardizing clinical medication and reducing the production of drug-resistant bacteria.