鲍曼不动杆菌1577株临床特征及耐药性分析

目的分析鲍曼不动杆菌感染的临床分布及其耐药性变迁，为临床抗菌药物的选择提供依据。方法回顾性分析2005—2012年各类临床标本分离出的鲍曼不动杆菌1577株的检出率、分布特点及药敏结果。结果2005-2012年共检出鲍曼不动杆菌1577株，检出率为4．3％。标本来源以痰液为主，占84．9％。科室分布以重症医学科最多，占39．9％，其次是呼吸内科，占26．8％。鲍曼不动杆菌对替卡西林、替卡西林／棒酸、哌拉西林和复方氨苄西林的耐药率最为严重，呈逐年上升趋势，2012年均已达70％以上；对哌拉西林／他巴唑、头孢他定、头孢吡肟、环丙沙星和复方磺胺甲嗯唑的耐药率也呈逐年上升态势，2012年均已达60％以上；亚胺培南和美罗培南的耐药率升高最为明显，由全部敏感上升到2012年的58．5％和68．7％；头孢哌N／舒巴坦和多黏菌素B的敏感性良好，耐药率均在10％以下。结论鲍曼不动杆菌的检出率和耐药性呈上升趋势，应连续监测其耐药性变化，合理选用抗菌药物，同时加强医院感染控制，防止耐药菌株的播散。

Analysis of clinical characteristics and antibiotics resistance of 1 577 strains of Acinetobacter baumannii

Objective To investigate the distribution and the change in drug resistance of the Acinetobacter baumannii,in order to provide reference for the choice of the antibacterial agents. Methods The detection rate, dis- tribution and drug resistance resuhs of Acinetobaeter baumannii isolated from various clinical specimens of the infec- tions from Jinhua Fifth Hospital during 2005-2012 were retrospectively analyzed. Results A total of 1 577 strains of Acinetobaeter banmannii were isolated during 2005-2012 ,the detection rate was 4.3%. Specimens of sputum-oriented sources were 84.9 %. Section distribution was mainly in ICU, which accounted for 39.9%, followed by the Department of Respiratory Medicine, which accounted for 26.8 %. The results of drug sensitive test showed that the resistance rate of Acinetobacter baumannii to ticarcillin, ticarcillin/clavulanie acid, piperacillin and compound ampieillin were more than 70% in 2012, piperacillin/tazobaetam, ceftazidime, cefepime, ciprofloxacin and compound sulfamethoxazole were more than 60%. Imipenem and meropenem-resistent rate increased most significantly, up to 58.5% and 68.7% in 2012. The resistance rate of cefoperazone/sulbactam and polymyxin B was below 10%. Conclusion The trend of de- tection rate and drug resistance of Acinetobacter banmannii is upward. So it is mandatory for hospital to arrange a con- tinuous monitoring on its susceptibility, choose the antibiotics reasonably and strengthen the control of the hospital in- fection, so as to prevent the spread of muhidrug-resistant Acinetobacter baumannii strains.