2013-2016年我院鲍曼不动杆菌感染分布特征及耐药性监测

目的 了解医院鲍曼不动杆菌(Aba)的临床分布及其耐药性,动态监测其耐药性发展情况,为临床合理使用抗菌药物和院内感染管理提供依据.方法 采用法国生物梅里埃公司VITEK-32细菌鉴定仪对2013年1月至2016年9月我院临床分离的Aba进行鉴定,并采用K-B纸片扩散法进行药敏试验,分析Aba的分布情况、耐药率及变化趋势.结果 824株Aba以痰标本检出率最高,ICU为主要高发科室(300株).Aba对头孢哌酮/舒巴坦的耐药率维持在较低水平,耐药率为9.3%~18.4%,对哌拉西林、哌拉西林/他唑巴坦、头孢曲松、头孢噻肟、头孢吡肟、阿米卡星、庆大霉素、左氧氟沙星、复方新诺明的耐药率均维持在较高水平,耐药率为52.1%~75.3%;对哌拉西林、哌拉西林/他唑巴坦、头孢他啶、头孢吡肟、头孢哌酮/舒巴坦、亚胺培南、庆大霉素、左氧氟沙星的耐药率呈逐年增加趋势.ICU科分离出的Aba对抗菌药物4年总体耐药率均明显高于非ICU科,差异有统计学意义(P<0.05).ICU科对头孢噻肟、庆大霉素、头孢曲松、复方新诺明、哌拉西林、左氧氟沙星的耐药率均较高(80.0%以上).多重耐药鲍曼不动杆菌2015年的检出率最高为53.1%,泛耐药鲍曼不动杆菌检出率呈逐年升高的趋势,分别为6.3%、9.6%、12.5%、17.1%.结论 我院鲍曼不动杆菌对常用抗菌药物的耐药率呈逐年上升趋势,多重耐药和泛耐药日益增多,应严格参照药敏试验结果合理用药,并加强医院感染管理.

Distribution characteristics and drug resistance monitoring of Acinetobacter baumannii from 2013 to 2016

Objective To understand the clinical distribution and drug resistance of Acinetobacter baumannii (Aba) in the hospital, to dynamically monitor the development of drug resistance, and to provide the basis for the clinical rational use of antibiotics and the management of nosocomial infections. Methods The clinical isolates of were identi-fied by the BioMerieux Vitek 32 microbial identification/susceptibility system (France) in our hospital from January 2013 to September 2016. Antimicrobial susceptibility test was determined Kirby-Bauer (K-B) disk diffusion method. The distribution, drug resistance rate and trends of Aba was analyzed. Results A total of 824 strains of Aba were isolat-ed and identified, of which sputum specimen had the highest detection resistance rate, ICU had the main high incidence (300 strains). Aba resistance rate to cefoperazone/sulbactam was remained at a low level, with the range of 9.3% to 18.4%. Aba resistance rates to piperacillin, piperacillin/tazobactam, ceftriaxone, cefotaxime, cefepime, amikacin, genta-micin, levofloxacin and cotrimoxazole were maintained at a high level, with the resistance rate range of 52.1% to 75.3%. Aba resistance rates to piperacillin, piperacillin/tazobactam, ceftazidime, cefepime, cefoperazone/sulbactam, imipenem and gentamicin, levofloxacin of the resistant rate were increased year by year. The total drug resistance rate of Aba in ICU was significantly higher than that of non-ICU Departments (P<0.05). The resistance rates of Aba isolat-ed from ICU to cefotaxime, gentamicin, ceftriaxone, cotrimoxazole, piperacillin, levofloxacin were high (more than 80%). Multiple drug resistant Acinetobacter baumannii in 2015 had the highest detection rate of 53.1%. Pan-resistant Acinetobacter baumannii was increasing from 2013 to 1016, with the detection rate of 6.3%, 9.6%, 12.5%, 17.1%, re-spectively. Conclusion The drug resistance rate of Acinetobacter baumannii to the commonly used antibiotics is increas-ing year by year in our hospital. Multi-drug resistance and pan-drug resistant are increasing day by day, so we should be reasonable to use drugs in strict accordance with the results of drug susceptibility testing, while strengthening the hospi-tal infection management.