耐亚胺培南鲍曼不动杆菌产碳青霉烯酶及耐药性变迁研究

目的研究临床分离的耐亚胺培南鲍曼不动杆菌产碳青霉烯酶以及菌株耐药性变迁情况。方法改良的Hodge试验检测耐亚胺培南鲍曼不动杆菌产碳青霉烯酶情况;K-B纸片扩散法对临床分离的耐亚胺培南鲍曼不动杆菌菌株进行药敏分析,了解耐药性变迁情况。结果临床分离的62株耐亚胺培南鲍曼不动杆菌改良Hodge试验阳性15株,阳性率为24.19%,且耐亚胺培南鲍曼不动杆菌产碳青霉烯酶率逐年上升。临床分离菌株主要来源于痰液及分泌物,病区以ICU最多(占20.97%),其次为急诊科和神经外科。耐亚胺培南鲍曼不动杆菌对常用17种抗菌药物的耐药性逐年升高,且以头孢哌酮/舒巴坦最低,其次为多粘菌素E。结论耐亚胺培南鲍曼不动杆菌耐药性升高主要是由于产生了碳青霉烯酶;头孢哌酮/舒巴坦对碳青霉烯类耐药鲍曼不动杆菌有较好的抗菌活性,可作为此类细菌感染的治疗药物。     

耐亚胺培南鲍曼不动杆菌耐药性分析

目的了解64株临床分离的耐亚胺培南鲍曼不动杆菌对18种常用抗生素的耐药性。方法采用Micro Scanwalk Away-40微生物分析仪进行菌株鉴定和药敏试验,头孢哌酮/舒巴坦及米诺环素药敏试验采用K-B法。结果亚胺培南耐药的鲍曼不动杆菌对头孢哌酮/舒巴坦的耐药率最低为37.5%,其次为米诺环素54.7%,对头孢噻肟、头孢曲松、哌拉西林、哌拉西林/他唑巴坦的耐药率最高为100.0%,其余抗菌药物的耐药率均大于81.1%。结论亚胺培南耐药的鲍曼不动杆菌多重耐药严重,部分为泛耐药菌株,仅对头孢哌酮/舒巴坦较为敏感。     

2006—2008年鲍曼不动杆菌耐药性变迁分析

目的：通过分析鲍曼不动杆菌耐药性的变化,为临床治疗鲍曼不动杆菌感染提供帮助。方法：收集2006年1月—2008年12月我院所分离出的鲍曼不动杆菌,采用K-B琼脂扩散法进行药敏试验。结果：2006—2008年,呼吸道分离的鲍曼不动杆菌占分离的81.4%;鲍曼不动杆菌头孢哌酮/舒巴坦的耐药性较低,亚胺培南和美诺培南的耐药性上升很快,ICU和非ICU病房对抗生素的耐药率有较大的差异。结论：鲍曼不动杆菌耐药现象呈明显上升趋势,特别是亚胺培南和美诺培南。非ICU病房鲍曼不动杆菌的耐药率低于ICU病房。     

鲍曼不动杆菌所致感染的临床分析

目的了解鲍曼不动杆菌的临床分布情况及细菌对抗生素的耐药情况。方法分析126株鲍曼不动杆菌标本的来源、科室分布、抗生素耐药性。结果 95例鲍曼不动杆菌感染最常见的为呼吸系统疾病,标本以痰液为最多;耐药情况较重,耐药率最低的为多粘菌素B,其次为丁胺卡那及米诺环素,亚胺培南、美罗培南及头孢哌酮舒巴坦耐药率较高;患者全部有应用抗生素病史;多重耐药及泛耐药鲍曼不动杆菌共占菌株数的96.03%。结论加强对鲍曼不动杆菌耐药性的监控,减少耐药菌株的产生。     

综合性医院重症监护室鲍曼不动杆菌耐药性分析

目的了解重症监护室病人鲍曼不动杆菌感染及耐药情况,指导临床医师选择有效抗生素进行抗感染治疗,控制院内感染的发生。方法 2008年1月～2010年1月期间,自重症监护室病人痰液等标本分离鲍曼不动杆菌,分析细菌的标本分布和科室分布,并检测细菌对常用抗生素的耐药性。细菌鉴定用VITEK-GNI+,药敏试验采用K-B法。结果分离出172株鲍曼不动杆菌,主要来自呼吸道感染病人的痰液,占87.21%;综合性重症监护室鲍曼不动杆菌的检出率较高,为43.60%(ICU-1)和29.65%(ICU-2)。药敏试验显示鲍曼不动杆菌对米诺环素、亚胺培南、含酶抑制剂的复合制剂如头孢哌酮/舒巴坦和哌拉西林/他唑巴坦以及左氧氟沙星的耐药率低,分别是1.32%、5.88%、4.71%、17.65%和23.53%,对其他抗生素有较强的耐药性。结论鲍曼不动杆菌是ICU病人呼吸道感染的常见菌,且耐药性高,建议首选米诺环素、亚胺培南、头孢哌酮/舒巴坦,哌拉西林/他唑巴坦和左氧氟沙星进行鲍曼不动杆菌的感染治疗。     

两种亚胺培南不敏感非发酵菌的耐药性分析

目的探讨亚胺培南不敏感铜绿假单胞菌及鲍曼不动杆菌的耐药性,为临床用药提供参考。方法对本院2010年1月~2014年12月间分离的亚胺培南不敏感铜绿假单胞菌及鲍曼不动杆菌进行统计分析。结果 403株亚胺培南不敏感鲍曼不动杆菌对常用抗菌药物耐药率很高,仅对头孢哌酮/舒巴坦、米诺环素和多粘菌素B保持较高的敏感性;113株亚胺培南不敏感铜绿假单胞菌对抗菌药物的敏感率高于亚胺培南不敏感鲍曼不动杆菌,对头孢他啶、头孢哌酮/舒巴坦、多粘菌素B、抗假单胞菌青霉素及其复合制剂有较高敏感性。结论两种亚胺培南不敏感非发酵菌对多数抗菌药物的耐药严重,应根据药敏结果选择抗菌药物,同时应采取恰当控制感染措施,以减少耐药菌株的产生与传播。     

2012～2014年呼吸道鲍曼不动杆菌药敏变化趋势

目的分析近3年鲍曼不动杆菌的药敏结果,了解其耐药情况和药敏变化规律,指导临床合理使用抗菌药物,预防和减少耐药菌产生。方法收集并分析2012年1月1日~2014年12月31日从本院呼吸道标本中分离的652株鲍曼不动杆菌药敏资料,并按年度进行统计和分析。结果氨苄西林/舒巴坦、米诺环素、庆大霉素、亚胺培南和复方新诺明等5种抗菌药对鲍曼不动杆菌体外敏感率呈上升趋势。复方新诺明(35.2%)和亚胺培南(15.7%)是敏感率增幅排在前2位的抗菌药。头孢哌酮/舒巴坦和阿米卡星的敏感率呈下降趋势,幅度分别为27.9%、5.8%。耐药率呈上升趋势的抗菌药共3种,分别为阿米卡星、头孢吡肟和头孢哌酮/舒巴坦。复方新诺明、亚胺培南和米诺环素等抗菌药的耐药率呈下降趋势。多粘菌素B耐药率在较低水平波动(4.3%~13.1%),其它抗菌药耐药率较高(35.5%~74.2%)。结论本院呼吸道鲍曼不动杆菌对米诺环素、多粘菌素B、头孢哌酮/舒巴坦等抗菌药较敏感。近3年复方新诺明和亚胺培南对鲍曼不动杆菌敏感率存在较大幅度增加,阿米卡星、头孢吡肟和头孢哌酮/舒巴坦等耐药率小幅增加。     

整合子介导鲍曼不动杆菌耐药机制的研究

目的研究鲍曼不动杆菌1类整合子和2类整合子的携带情况,并对比分析其与临床耐药率的关系。方法收集中南大学湘雅二医院2008年9月～2009年9月分离的70株鲍曼不动杆菌,采用K-B法对鲍曼不动杆菌进行临床常见15种抗生素药物敏感试验。利用聚合酶链反应检测1类整合子和2类整合子基因。结果药敏试验显示鲍曼不动杆菌对氨曲南的耐药率最高,为72.86%;对头孢哌酮/舒巴坦耐药性最低,为15.71%。PCR检测鲍曼不动杆菌1类整合子携带率为57.14%(40/70),2类整合子携带率为7.14%(5/70)。与1类整合子阴性菌株相比,阳性菌株对头孢哌酮/舒巴坦的耐药率相近(χ2=1.47,P>0.05),对其他14种抗菌药物的耐药率为55.00%～82.50%,其中对碳青霉烯类抗生素亚胺培南和美罗培南耐药率两组菌间差异无统计学意义(P>0.05),对其余抗菌药物耐药率差异有统计学意义(P<0.01)。结论鲍曼不动杆菌主要携带1类整合子,且1类整合子与不动杆菌多重耐药关系密切。     

重症监护病房肺部感染鲍氏不动杆菌的耐药性分析

目的分析鲍曼不动杆菌肺部感染的临床特点及耐药性,为临床医师诊断和治疗提供依据。方法对2006年10月至2010年10月期间,ICU及神经外科重症监护病房住院患者确诊为肺部感染的呼吸道标本中分离的鲍曼不动杆菌324株,采用K-B法进行药敏试验,结果判定按CLSI标准。结果对常用抗菌药物耐药性逐年增加,头孢哌酮/舒巴坦耐药率最低为16.5%,其次为亚胺培南19.8%和美罗培南24.4%,对其余13种抗菌药物的耐药率均在46.4%～96.4%。结论临床对鲍氏不动杆菌引起医院感染应高度重视,应合理应用抗菌药物以减少耐药菌株的产生。     

二级医院鲍曼不动杆菌感染的临床特征和同源性分析

目的：研究二级医院鲍曼不动杆菌感染患者的临床特征,对耐碳青霉烯鲍曼不动杆菌进行同源性分析,为临床治疗和医院感染控制提供依据。方法收集临床分离的115株非重复性鲍曼不动杆菌,回顾性分析患者的临床资料和细菌药敏资料。采用 Vitek2 Compact 对115株鲍曼不动杆菌进行19种抗菌药物的敏感性检测。采用肠杆菌科基因间一致重复序列聚合酶链技术(ERIC-PCR)对其中的耐碳青霉烯鲍曼不动杆菌进行基因分型和同源性分析。结果115例患者主要集中在 ICU、干部病房和呼吸科病房。患者的平均年龄为(75±16)岁。平均住院时间52.1 d。最常见的合并症为COPD 和糖尿病。72例(62.61%)患者曾接受侵入性操作。86例(74.78%)患者病程中使用过2种及以上的抗生素。48例(41.74%)患者接受机械通气。115株鲍曼不动杆菌对多黏菌素 B 耐药率最低,为0%,其次为替加环素,耐药率7.83%。仅头孢哌酮/舒巴坦、阿米卡星耐药率低于40%,对其他常用抗生素的耐药率均高于50%。对亚胺培南和美罗培南的耐药率分别达56.52%和58.26%。ERIC-PCR 技术将67株耐碳青霉烯鲍曼不动杆菌分为9个基因型。结论二级医院鲍曼不动杆菌感染患者的临床特征为：高龄,住院时间长,合并基础疾病,接受侵入性操作,接受机械通气及使用多种抗生素。对常用的抗生素高度耐药。多重耐药鲍曼不动杆菌及广泛耐药鲍曼不动杆菌存在院内接触传播的现象,因此应该提高医护人员消毒意识,加强耐药性监测及合理使用抗菌药物。     

Risk factors for nosocomial bloodstream infections due to Acinetobacter baumannii: a case-control study of adult burn patients.

Risk factors for Acinetobacter baumannii bloodstream infection (BSI) were studied in patients with severe thermal injury in a burn intensive care unit where A. baumannii was endemic. Of 367 patients hospitalized for severe thermal injury during the study period, 29 patients with nosocomial A. baumannii BSI were identified (attack rate, 7.9%). Cases were compared with 58 matched controls without A. baumannii BSI. The overall mortality rate was 31% among cases and 14% among controls; only two deaths (7%) were considered directly related to A. baumannii BSI. Molecular typing of A. baumannii blood isolates by means of randomly amplified polymorphic DNA analysis and pulsed-field gel electrophoresis revealed the presence of three different strain types. Multivariate analysis showed that female gender (P = .027), total body surface area burn of > 50% (P = .016), prior nosocomial colonization with A. baumannii at a distant site (P = .0002), and use of hydrotherapy (P = .037) were independently associated with the acquisition of A. baumannii BSI in burn patients. These data underscore the need for effective infection control measures for this emerging nosocomial problem.     

2007-2010年医院鲍曼不动杆菌感染的耐药分析

目的 了解医院鲍曼不动杆菌感染的分布及耐药情况.方法 分析鲍曼不动杆菌菌株的标本来源和临床分布情况,用最低抑菌浓度(minimal inhibitory concentration,MIC)法结合纸片扩散法(K-B法)检测其对抗菌药物的敏感性.结果 2007-2010年共分离鲍曼不动杆菌62株,其中53株(占85.5%)分离自痰标本,21株(占33.9%)分离自重症监护室(intensive care units,ICU).62例患者中54.8%(34例)的患者患有严重的肺部感染疾病.分离菌对头孢哌酮/舒巴坦的耐药率为20.0%、敏感率为73.3%,对其他抗菌药物的耐药率超过60.0%.泛耐药菌占33.9%(21株),其中52.4%(11株)的泛耐药鲍曼不动杆菌感染发生在ICU病房.结论 鲍曼不动杆菌的耐药率较高,且呈多重耐药趋势.加强菌株的耐药性监测,以药敏结果指导临床用药有助于减少耐药菌株的出现.

Abstract：

Objective To investigate the prevalence and antimicrobial resistance of Acinetobacter baumannii in nosocomial infection.Methods Clinical features and the origin of A.baumannii samples were analyzed retrospectively.The minimal inhibitory concentration(MIC)and Kriby-Bauer diffusion test(K-B)were used to determine the Susceptibility to the antimicrobial agents.Results A total of 62 strains of A.baumannii were isolated from 2007 to 2010.Fifty-three strains(85.5%) of specimens were separated from respiratory tract.The isolation rate of A.baumannii was the highest in intensive care units(ICU)(21 strains,33.9%).54.8%(34/62)of patients suffered from severe lung infection.The resistance rate of cefoperazon/sulbactam was 20.0%.and the susceptible rate was 73.3%.The resistance rate to other antimicrobial agents is above 60.0%.The prevalence of multi-drug resistance of A.baumannii Was about 33.9%,and 52.4% of this kind of A.baumannii were occured in ICU.Condusion The infection of A.baumannii is more and more severe and tends to be resistant to multiple-drug and pan-drugs.The susceptible testing should be conducted to help the clinic to decrease the resistance rate.     

Multidrug resistance Acinetobacter species at the intensive care unit,Aseer Central Hospital,Saudi Arabia:A one year analysis

Objective:To identify and to determine the antimicrobial susceptibility of Acinetobacter baumannii(A.baumannii) clinical isolates from ICU at Aseer Central Hospital.Methods:The study was conducted in the Intensive Care Unit,Aseer Central Hospital,Saudi Arabia over 13 months period(2014-2015).Acinetobacter species(n= 105) were isolated from various clinical samples.Isolates were identified using selected phenotypic criteria and confirmed using the Vitek 2 automated system.This system was used to determine the susceptibilities of 21 antimicrobial agents.Patients,isolates and drug data were analyzed using the SPSS statistical software package to determine some epidemiological and microbiological patterns.Results:Of the 105 stains,A.baumannii accounted for 49(46.67%),A.baumannii complex,19(18.09%),A.baumannii/haemolyticus 32(30.47),Acinetobacter haemolyticus 4(3.81%),Acinetobater lwoffii 1(0.95%) and unidentified Acinetobater species 2(1.3%).Of the 105 Acinetobacter strains,103(98.1%) were found multidrug resistant(MDR).A.baumannii strain were 100% sensitive to colistin and 74.5% to trimethoprim + sulfamethoxazole.The remaining 19 antimicrobial agents revealed low or no sensitivities:amikacin 16.3%; ampicillin 7.7%; ceftazidime 7.3%.Distribution of similar sensitivities was shown by other Acinetobacter species.Mean number of isolates from males and females indicates no statistical variation(P=0.867) whereas age groups showed significant differences(P= 0.008) as it is clear from the high percentage of infected individuals more than 60 years followed by those aged 20 to 29 years old(19.05%).Upper respiratory tract(30.48%),lower respiratory tract(47.65%) and subcutaneous tissue(9.5%) were the main sources of Acinetobacter spp.but mean numbers of isolates from these specimens indicate no discrepancy between specimens(P=0.731).Conclusions:Acinetobacterspecies including A.baumannii were found MDR(98.1%) according to the current Acinetobacter spp.antimicrobial categorization.Approximately half of these strains were A.baumannii.All Acinetobacter species were 100% sensitive to colistin and to some extent to trimethoprim + sulfamethoxazole(74.5%).ICU-acquired pneumonia among patients over 60 years of age who spend prolong times at artificial ventilations made up the majority of the cases.     

Citywide clonal outbreak of multiresistant Acinetobacter baumannii and Pseudomonas aeruginosa in Brooklyn,NY: the preantibiotic era has returned

BACKGROUND: Carbapenems are important agents for treating nosocomial gram-negative infections. Carbapenem-resistant bacteria have become increasingly problematic in certain regions. This study determined the citywide prevalence and molecular epidemiological features of carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa in Brooklyn, NY. METHODS: All unique patient isolates of A baumannii and P aeruginosa were collected from 15 Brooklyn hospitals from July 1, 1999, through September 30, 1999. Antibiotic susceptibilities, the genetic relatedness of resistant isolates, and the relationship between antibiotic use and resistance rates were determined. RESULTS: A total of 419 isolates of A baumannii and 823 isolates of P aeruginosa were collected. For A baumannii, 53% were resistant to meropenem and/or imipenem, and 12% were resistant to all standard antibiotics. Ribotyping revealed that a single clone accounted for 62% of the samples and was isolated from patients at all 15 hospitals. The rate of carbapenem resistance was associated with cephalosporin use at each hospital (P =.004). For P aeruginosa, 24% were resistant to imipenem, 5% to amikacin, and 15% to 29% to other antipseudomonal agents. Ribotyping revealed that 3 clones accounted for nearly half of the isolates and were shared by most hospitals. CONCLUSIONS: Approximately 400 patients were infected or colonized with carbapenem-resistant A baumannii and P aeruginosa during a 3-month period in 1999. A few strains have spread widely throughout hospitals in this region. The prevalence of resistant A baumannii seems to be correlated with cephalosporin use. Multiresistant hospital-acquired bacteria should be viewed as a serious public health issue rather than an individual hospital's problem. An intensive coordinated effort will be needed to effectively address this problem.     

骨科患者术后创面感染鲍曼不动杆菌对喹诺酮类抗菌药物的耐药性分析

目的了解医院骨科患者手术后创面感染的鲍曼不动杆菌的耐药情况,以指导医生合理用药,有效控制鲍曼不动杆菌耐药性的进一步发展,预防和减少医院感染的发生。方法从骨科患者手术后创面感染标本分离鲍曼不动杆菌28株,作gyrA基因测序,并进行BLASTn比对;通过测定最小抑菌浓度(minimum inhibitory concentration,MIC)进行药敏试验,测定鲍曼不动杆菌的耐药性;选取经纯培养的鲍曼不动杆菌菌落置入含蛋白酶K溶液的离心管内,分别进行水浴,再离心,留取上清液,以此为模板PCR扩增与喹诺酮类抗菌药物耐药性相关的gyrA、qepA、qnrS、qnrA、qnrB和aac(6)-Ib基因,使用Chromas分析软件进行测序。结果鲍曼不动杆菌对诺氟沙星、氧氟沙星、培氟沙星、依诺沙星、环丙沙星、司帕沙星、左氧氟沙星、加替沙星、莫西沙星的耐药率分别为:96.43%、96.43%、96.43%、89.29%、85.71%、85.71%、82.14%、78.57%和78.57%。PCR检测28株鲍曼不动杆菌gyrA基因100%阳性,即都发生了gyrA基因突变,而其他相关基因检测均阴性。基因测序看出,其83位发生突变,即由TCA转变为TTA。结论本组分离骨科患者手术创面感染的鲍曼不动杆菌对喹诺酮类抗菌药物的耐药情况严重,其中对诺氟沙星、氧氟沙星、培氟沙星等的耐药率均在90%以上。临床抗感染治疗应根据耐药结果进行用药,并控制喹诺酮类抗菌药物的使用。     

铜绿假单胞菌抗菌物质体外对鲍曼不动杆菌的抑制作用研究

目的观察铜绿假单胞菌抗菌物质对鲍曼不动杆菌的体外抑菌活性。方法用交叉条带试验方法测定铜绿假单胞菌对15株鲍曼不动杆菌的体外抑制活性。结果铜绿假单胞菌对鲍曼不动杆菌体外抑菌活性良好,15株产色素铜绿假单胞菌中,除4、8、14、15号菌株外,其余铜绿假单胞菌对鲍曼不动杆菌的抑制率均为100％。并发现铜绿假单胞菌产色素菌株的抗菌活性显著优于不产色素菌株。铜绿假单胞菌主要通过产生的绿脓素抑制鲍曼不动杆菌的生长。结论铜绿假单胞菌产生的抗菌物质对鲍曼不动杆菌具有较强的抗菌活性,具有广阔的开发前景。     

鲍曼不动杆菌感染的危险因素及耐药性分析

目的 了解我院鲍曼不动杆菌的感染危险因素及耐药性.方法 经采用常规方法进行细菌培养、菌株鉴定及药敏检测.结果 158例患者共分离出238株鲍曼不动杆菌,患者主要集中在老年科(27.8％)、呼吸内科(26.6％)、神经内科(24.1％)、ICU( 16.5％),基础疾病以肺部疾病(77.8％)、神经系统疾病(51.9％)、心血管疾病(43.0％)、糖尿病(32.9％)多见,与有创检查或治疗(64.6％)、使用广谱抗生素(86.1％)可能存在相关性.对头孢哌酮/舒巴坦敏感性(66.4％)较高.对碳青霉烯类抗生素耐药性逐年上升,由20.4％上升至40.2％.结论鲍曼不动杆菌耐药情况严重,对碳青霉烯类耐药率逐年上升,可能与患者基础疾病、有创性检查或治疗、使用广谱抗生素有关.     

重症医学科下呼吸道感染病原菌分析及干预对策

【】 目的 研究重症医学科下呼吸道感染患者病原菌分布特点、耐药情况及干预措施。方法 分析2011年1月-2013年12月入住内蒙古医科大学附属医院重症医学科患者送检的痰标本中分离出的病原菌,并用纸片扩散法进行药物敏感试验,进行病原菌耐药性分析。结果 分离出病原菌348株,以革兰氏阴性杆菌为主,共225株占64.66%,其中鲍曼不动杆菌、大肠埃希菌和铜绿假单胞菌居多,鲍曼不动杆菌、铜绿假单胞菌对头孢哌酮/舒巴坦耐药率较低,分别为55.81%、44.74%,大肠埃希菌和肺炎克雷伯菌对亚胺培南、美罗培南均敏感,耐药率为0；革兰氏阳性球菌93株,占26.72%,以金黄色葡萄球菌为主,对万古霉素、替考拉宁耐药为0；真菌30株占8.62%,白色念珠菌对常见抗真菌药耐药率为0,热带假丝酵母菌、光滑假丝酵母菌对氟康唑耐药率分别为60%和66.67%,对伏立康唑耐药率为0。结论 监测重症医学科患者下呼吸道感染病原菌种类及其耐药性的变化,对合理使用抗感染药物,制定干预对策有重要意义。