四川地区鲍曼不动杆菌、医院不动杆菌及皮特不动杆菌实验室检出情况与耐药性分析

Laboratory detection and drug resistance analysis of Acinetobacter baumannii,Acinetobacter nosocomialis and Acinetobacter pitt in Sichuan area

目的分析四川省细菌耐药监测网2021—2023年间鲍曼不动杆菌、医院不动杆菌以及皮特不动杆菌各成员单位分离鉴定及报告情况,以及各菌株科室、标本分布和抗菌药物耐药性差异,为临床微生物菌种鉴定以及临床抗菌药物选择提供参考。方法利用WHONET5.6软件对2021—2023年四川省细菌耐药监测网成员共111家单位上报数据中上述3种细菌的科室分布、标本及药敏结果数据进行比较分析。并通过问卷星对四川省细菌耐药监测核心网成员单位进行基质辅助激光基质电离飞行时间质谱仪使用情况的调查。结果本次研究共纳入51918株细菌,其中鲍曼不动杆菌占98.6%,皮特不动杆菌占1.2%,医院不动杆菌占0.2%。111家医院中仅7家医院(6.3%)有医院不动杆菌和皮特不动杆菌的报告。3种细菌主要分离于呼吸道样本,鲍曼不动杆菌和医院不动杆菌主要分离自ICU、呼吸内科和神经内科,皮特不动杆菌主要分离自呼吸内科、神经外科和外科。鲍曼不动杆菌对所有抗菌药物耐药性均显著高于医院不动杆菌和皮特不动杆菌。结论鲍曼不动杆菌复合群由于通过生化反应难以进行区分,造成微生物实验室通常并未区分至菌种,但由于上述3种细菌样本来源、分离科室以及耐药性均有明显差异,提示微生物实验室应尽量使用基质辅助激光基质电离飞行时间质谱仪对菌种进行准确鉴定并加强耐药监测,以指导临床合理经验用药。

Objective To analyze the isolation,identification and reporting of Acinetobacter baumannii,Acinetobacter nosocomialis and Acinetobacter pittii in the member units of the Sichuan Antimicrobial Surveillance Network from 2021 to 2023,as well as the distribution of strains in departments,the distribution of specimen sources,and the differences in antimicrobial resistance,in order to provide a reference for the isolation of clinical strains and the selection of clinical antimicrobial agents.Methods The use by matrix-assisted laser desorption ionization-time of flight mass spectrometry was conducted by questionnaire survey among the member units of the core network of the Sichuan Antimicrobial Surveillance Network.Comparative analysis of departmental distribution,specimen,and antimicrobial susceptibility result data of the above three bacteria in the data reported by a total of 111 members of the Sichuan Antimicrobial Surveillance Network from 2021 to 2023 was performed using WHONET 5.6 software.Results A total of 51,918 clinical strains were included in this study,of which A.baumannii accounted for 98.6%,A.pittii for 1.2%and A.nosocomialis for 0.2%.Only 7 hospitals(6.3%)out of 111 hospitals had reports of A.nosocomialis and A.pittii.The three bacteria were mainly isolated from respiratory samples,A.baumannii and A.nosocomialis were mainly isolated from intensive care,respiratory medicine and neurology,and A.pittii was mainly isolated from respiratory medicine,neurosurgery and surgery.The resistance rate of A.baumannii was significantly higher than that of A.nosocomialis and A.pittii.Conclusion The A.baumannii complex is difficult to differentiate by biochemical reactions,resulting in microbiological laboratories usually not differentiating to strains.Due to the obvious differences between A.baumannii,A.nosocomialis and A.pittii in terms of isolation samples,isolation departments and antimicrobial resistance,therefore,clinical microbiology laboratories should use a variety of techniques to accurately identify relevant strains of the A.baumannii complex in order to guide rational empirical clinical use.