2006-2009年鲍曼不动杆菌和铜绿假单胞菌耐药性分析

目的：调查鲍曼不动杆菌和铜绿假单胞菌对临床常用15种抗菌药物产生耐药的趋势,为合理选用抗菌药提供依据。方法：对2006-2009年首都医科大学宣武医院住院患者的血、尿、痰、脓液等标本中分离培养的鲍曼不动杆菌和铜绿假单胞菌,采用常规方法和梅里埃VITEK32型全自动微生物鉴定和药敏系统进行细菌鉴定和药敏试验。结果按照美国临床实验室标准研究所（CLSI）2008年版标准判定。结果：2006-2009年鲍曼不动杆菌分离率分别为8.7%（251/2885）、7.6%（218/2868）、7.6%（172/2263）和13.1%（396/3023）,2009年的分离率明显升高;铜绿假单胞菌的分离率分别为14.5%（417/2885）、13.3%（382/2868）、14.1%（319/2263）和10.7%（322/3023）,分离率呈下降趋势。2006-2009年鲍曼不动杆菌对12种抗菌药的耐药率均上升,其中对亚胺培南和美罗培南的耐药率分别从2006年的10.4%和11.2%上升至2009年的56.3%和57.1%,对头孢吡肟及哌拉西林-他唑巴坦的耐药率分别从2006年的22.7%和20.3%上升至2009年的64.1%和52.5%,2009年鲍曼不动杆菌对头孢哌酮-舒巴坦耐药率最低（26.8%）,其余14种抗菌药的耐药率均高于50%。铜绿假单胞菌对哌拉西林-他唑巴坦和头孢吡肟的耐药率分别从2006年的22.8%和18.6%上升至2009年的29.2%和38.8%,2006年对亚胺培南和左氧氟沙星的耐药率分别为42.4%和45.8%,2009年分别下降至35.4%和37.9%,对其余11种抗菌药的耐药率无明显变化,2009年铜绿假单胞菌对头孢哌酮-舒巴坦耐药率最低（15.0%）。结论：分析鲍曼不动杆菌和铜绿假单胞菌的耐药率有利于合理选用抗菌药物和预防耐药菌株的传播。治疗该两菌引起的感染,可考虑选用头孢哌酮-舒巴坦。

Analysis of drug resistance of Acinetobacter baumannii and Pseudomonas aeruginosa during the period 2006-2009

Objective：To investigate the trend in development of resistance of Acinetobacter baumannii and Pseudomonas aeruginosa to 15 different kinds of commonly used antibacterial agents in clinical practice in order to provide a basis for appropriate selection of antibacterial agents. Methods：The strains of Acinetobacter baumannii and Pseudomonas aeruginosa were isolated from blood,urine,sputum,pus and other specimens from inpatients in Xuanwu Hospital of Capital Medical University during the period 2006-2009. The identification of bacteria and antimicrobial susceptibility testing were performed by a routine method and VITEK 32 automatic measurement system. The results were evaluated according to CLSI 2008. Results：Isolation rates of Acinetobacter baumannii during the period 2006-2009 were 8.7%（251/2 885）,7.6%（218/2 868）,7.6%（172/2 263）and 13.1%（396/3 023）,respectively. The isolation rate in 2009 increased markedly. Isolation rates of Pseudomonas aeruginosa during the period 2006-2009 were 14.5%（417/2 885）,13.3%（382/2 868）,14.1%（319/2 263）and 10.7%（322/3 023）,respectively. The isolation rate decreased year by year. Resistance rates of Acinetobacter baumannii to 12 different types of antibacterial agents during the period 2006-2009 increased：resistance rate of Acinetobacter baumannii to imipenem and meropenem were 10.4% and 11.2% in 2006 and increased to 56.3% and 57.1% in 2009,respectively. Resistance rate of Acinetobacter baumannii to cefepime and piperacillin-tazobactam were 22.7% and 20.3% in 2006 and increased to 64.1% and 52.5% in 2009,respectively. The resistance rate of Acinetobacter baumannii to cefoperazone-sulbactam was the lowest （26.8%） in the 15 antibacterial agents and that to other 14 antibacterial agents was higher than 50%. Resistance rates of Pseudomonas aeruginosa to piperacillin-tazobactam and cefepime were 22.8% and 18.6 % in 2006 and increased to 29.2% and 38.8% in 2009,respectively. Resistance rates of Pseudomonas aeruginosa to imipenem and levofloxacin were 42.4% and 45.8% in 2006,and decreased to 35.4% and 37.9% in 2009,respectively,and those to other 11 antibacterial agents were stable. The resistance rate of Pseudomonas aeruginosa to cefoperazone-sulbactam in 2009 was the lowest （15.0%）. Conclusion：Analysis of the resistance rate of Acinetobacter baumannii and Pseudomonas aeruginosa is beneficial to the appropriate choice of antibacterial agents and preventing transmission of drug-resistant strains.Ceroperazone-sulbactam may be considered the drug of choice in the treatment of the infections caused by the two bacteria.