新疆地区多重耐药鲍曼不动杆菌耐药及分布特点

目的了解新疆地区多重耐药鲍曼不动杆菌(multidrug-resistant Acinetobacter baumnnii MDRAB)耐药及分布特点,指导临床合理用药。方法收集新疆地区36家医院2014年1月-2017年12月各类送检标本。采用全自动微生物鉴定仪和纸片扩散法(K-B法)及采用美国临床和实验室标准协会(CLSI)推荐的琼脂二倍稀法测定抗菌药物的最低抑菌浓度(minimal inhibitoryconcentration,MIC)值。按统一方案对新疆地区36家医院分离的MDRAB进行抗菌药物敏感性试验,依据2017版CLSI标准判读结果,并用WHONET5.6软件进行统计分析。结果共分离出MDRAB 10536株,MDRAB主要来自重症监护室,老年病科,呼吸科。标本分布主要来源痰8734株,尿液558株,分泌物411株,导管尖306株,血中242株,腹水94株,胸水63株,脑脊液42株,其他86株。MDRAB对多黏菌素B敏感率为100%,对碳青霉烯类如亚胺培南,头孢第三代、第四代如头孢曲松,头孢吡肟等耐药率达到50%~60%。结论 MDRAB的检出率波动不大,无明显增髙或降低趋势。应合理使用抗菌药物,减少耐药菌株的蔓延,并采取预防感染的有效措施。

Drug-resistance and distribution characteristics of multi-drug resistant Acinetobacter baumannii in Xinjiang

Objective To understand the resistance and distribution characteristics of multidrug resistant Acinetobacter baumannii (MDRAB) in Xinjiang and to guide clinical rational drug use. Methods Samples were collected from all types of hospitals including 36 hospitals in Xinjiang from January 2014 to December 2017. The minimum inhibitory concentration (MIC) values of the antibacterial drugs were determined usinga fully automated microbial identification instrument, the disk diffusion method (KB method) and the agar double dilution method recommended by the American Society for Clinical and Laboratory Standards Institute (CLSI). The antimicrobial susceptibility testing of the isolated multidrug-resistant Acinetobacter baumannii isolated from 36 hospitals in Xinjiang according to a unified plan were carried out. The results were interpreted based on the 2017 version of the CLSI standard. The WHONET 5.6 software was used for the statistical analysis. Results A total of 10,536 strains of multi-drug resistant Acinetobacter baumannii were isolated. The multi-drug resistant Acinetobacter baumannii (MDRAB) was mainly from the intensive care unit, the geriatrics department, and the respiratory department. The specimens were distributed mainly from 8,734 strains, including 558 strains from urine, 411 strains from secretions, 306 strains from catheter tips, 242 strains from blood samples, 94 strains from ascites, 63strains from pleural effusions, 42 strains from cerebrospinal fluids, and 86 strains from other samples. The sensitivity of MDRAB to polymyxin B was 100%, and the resistance rates to carbapenems such as imipenem, cephalosporins, ceftriaxone, and cefepime, reached 50%~60%. Conclusion The detection rate of multi-drug resistant Acinetobacter baumannii fluctuated little, with no significant increasing or decreasing trends. Antibiotics should be used rationally to reduce the spread of drug-resistant strains and effective measures must be taken to prevent