2012-2015年鲍曼不动杆菌耐药性变迁及抗菌药物选择

目的：通过分析鲍曼不动杆菌的耐药性变化，为临床治疗鲍曼不动杆菌感染遴选适宜的抗菌药物。方法：采用VITEK-2 COMPACT全自动细菌鉴定仪进行分离鉴定，按CLSI推荐的K-B法及CLSI 2014年标准判定细菌耐药性，对某院2012-2015年临床分离的鲍曼不动杆菌的分布与耐药性变化进行回顾性分析。结果：鲍曼不动杆菌的分离率和耐药率呈上升趋势，但多重耐药鲍曼不动杆菌的分离率呈下降趋势。该菌大多数分离自痰液和支气管吸出物，检出率最高的科室是ICU病房。近4年来鲍曼不动杆菌对大多数常用抗菌药物的耐药率较高且保持稳定，对以前敏感率高的头孢哌酮舒巴坦、米诺环素、美罗培南的耐药率呈上升趋势。结论：应加强鲍曼不动杆菌的耐药监测，合理使用抗菌药物，可选择多黏菌素E、含舒巴坦复合制剂、米诺环素和替加环素等。

Changes of antimicrobial resistance and choice of antimicrobial agents of Acinetobacter baumannii from 2012 to 2015

OBJECTIVE To analyze changes of antimicrobial resistance of Acinetobacter baumannii and select appropriate drugs to treat Acinetobacter baumannii.METHODS Isolation and identification were performed by VITEK-2 COMPACT automatic microbial analysis system,antimicrobial resistances test by K-B method recommended by CLSI,and the results were judged in accordance with the 2014 guidelines of the CLSI.Distribution and drug resistance of Acinetobacter baumannii were retrospectively reviewed in Daqing Hospital from 2012 to 2015.RESULTS The isolation proportion and resistant rate of Acinetobacter baumannii were increasing.But the isolation proportion of multidrug resistant Acinetobacter baumannii assumed a lowing trend.Most of the samples came from sputum and bronchial aspirate.The most strains were from intensive care unit.The drug resistance rate of Acinetobacter baumannii to commonly used antibiotics was high and stable in four years.The resistance to high sensitivity agents before,such as cefoperazone-sulbactam,minocycline,mecropenem,showed an increasing tendency.CONCLUSION Surveillance of Acinetobacter baumannii and rational use of antibiotics should be enhanced.Polymyxins E,compound preparation with sulbactam,minocycline and tigecycycline are optional drugs.