综合医院鲍曼不动杆菌的临床分布及耐药分析

目的研究鲍曼不动杆菌的感染现状,分析其耐药性变化趋势,为临床合理用药提供试验依据。方法采用VITEK-2对临床分离株进行鉴定和药敏试验,耐药性数据分析采用WHONET5.6软件,结果判定按照美国临床和实验室标准化委员会2014年标准。结果 2013-2015年同济大学附属杨浦医院患者首次分离鲍曼不动杆菌981株,其临床分布以呼吸道标本为主,占80.4%;其次是尿液及分泌物,分别占8.8%和8.5%。科室分布以ICU最多,占30.1%;其次是急诊观察室(16.0%)、呼吸科(15.7%)及老年干部科(10.8%)。鲍曼不动杆菌对多黏菌素B和头孢哌酮/舒巴坦最为敏感,耐药率5.0%;其次,较敏感的是阿米卡星和米诺环素,耐药率30.0%;而对其他抗菌药物耐药率均30.0%,其中耐药最严重的是呋喃妥因和头孢噻肟,耐药率达94.0%以上。在不同年度中,2014年相对于2013年鲍曼不动杆菌对大多数抗菌药物耐药性和分离株数均有所下降,但是2015年却出现明显上升。结论同济大学附属杨浦医院鲍曼不动杆菌感染主要来源于痰标本,多分布于ICU、急诊观察室、呼吸科和老年干部科;对抗菌药物的耐药率较高,应做好院内感染防控工作,合理使用抗菌药物,减少耐药菌株的传播。

Clinical distribution and drug resistance trend of Acinetobacter baumannii and analysis on its drug resistance in comprehensive hospital

Objective This work was to study the distribution of Acinetobacter baumannii and analyze the change in the trend of its resistance,so as to provide experimental basis for clinical rational drug usage.Methods The identification of isolates were car-ried out by using VITEK-2 compact automatic identification system,and drug susceptibility testing was performed by disc diffusion method,the results were carried out according to the Standard of CLSI 2014 version for interpretation,and data analysis was per-formed with WHONET5.6.Results A total of 981 strains of Acinetobacter baumannii had been isolated from the samples in 2013 to 2015,most of them were isolated from respiratory samples accounted for 80.4%,followed by the urines and other body secre-tion.The distribution of this kind of bacteria mostly was 30.1% in ICU,departments of Emergency observation(16.0%),respirato-ry diseases(15.7%)and senior cadres(10.8%).The drug resistance of this kind of bacteria to polymyxin B and cefoperazone/sul-bactam was to a minimum of lower than 5.0%,and has relatively high sensitivity to amikacin and minocycline(<30.0%).And the resistance to other antimicrobials were higher than 30.0%,and the resistance to Nitrofurantoin and cefotaxime were higher than 94.0%.The most drug resistance of Acinetobacter baumannii in 2014 were lower than those in 2013,but the most drug resistance of Acinetobacter baumannii in 2015 were increased significantly as well as strains had been isolated from the samples.Conclusion The main source for isolation of Acinetobacter baumannii in this hospital mainly comes from sputum specimens of patients in ICU, departments of emergency observation,respiratory diseases and senior cadres.The high prevalence of antimicrobial resistance of this kind of bacteria should be prevented and controlled in nosocomial infection,and rational application of antimicrobial agents in order to reduce the spread of drug-resistant strains.