医院获得性肺炎中鲍曼不动杆菌耐药性变化

目的研究医院获得性鲍曼不动杆菌(AB)肺炎的细菌耐药情况,以指导临床规范用药,降低耐药率。方法回顾性分析某院2009—2012年发生的医院获得性AB肺炎患者临床资料,采用统一的方案、方法和判断标准进行AB耐药性数据汇总和统计分析。结果共有284例医院获得性AB肺炎患者,主要分布于综合重症监护病房(ICU,45.07%)、呼吸科(19.01%)、神经外科(9.15%)、神经内科(5.99%)。医院获得性AB肺炎的感染发病率及多重耐药AB(MDR-AB)、泛耐药AB(XDR-AB)的感染发病率呈上升趋势。总体耐药率以头孢哌酮/舒巴坦(9.51%)和米诺环素(9.86%)较低,左氧氟沙星(43.66%)和环丙沙星(45.42%)较高;对亚胺培南的耐药率为16.20%,美罗培南为20.42%。AB对美罗培南、亚胺培南、头孢哌酮/舒巴坦、氨苄西林/舒巴坦的耐药率呈逐年上升趋势,差异均有统计学意义(均P0.05)。结论 AB耐药现象严重,应加强AB耐药性监测,防止医院内传播。

Change in antimicrobial resistance of Acinetobacter baumannii causing hospital acquired pneumonia

ObjectiveTo investigate antimicrobial resistance of Acinetobacter baumannii (A. baumannii) causing hospital acquired pneumonia (HAP)， so as to guide rational use of antimicrobial agents and reduce antimicrobial resistant rate.MethodsClinical data of patients with A. baumannii HAP in a hospital between 2009 and 2012 were collected and analyzed retrospectively. Antimicrobial resistance data were summarized and analyzed statistically according to uniformed methods.ResultsA total of 284 patients developed A.baumannii HAP， patients mainly distributed in intensive care unit（45.07%）, department of respiratory diseases（19.01%）, neurosurgery （9.15%）, and neurology（5.99%）. The incidences of A. baumannii HAP，multidrug resistant A. baumannii (MDR AB) HAP， and extensively drug resistant A. baumannii (XDR AB) HAP increased year by year. The total resistant rates of A. baumannii to cefoperazone/sulbactam (9.51%) and minocycline(9.86%) were low, to levofloxacin(43.66%) and ciprofloxacin(45.42%) were relatively higher; resistant rates to imipenem and meropenem were 16.20% and 20.42% respectively. The resistant rates to meropenem, imipenem, cefoperazone/sulbactam, and ampicillin/sulbactam increased year by year (all P<0.05).ConclusionAntimicrobial resistance of A. baumannii is serious, it is essential to strengthen the monitoring of antimicrobial resistance of A.baumannii, and prevent the spread in hospital.