鲍曼不动杆菌感染分布及耐药性的变迁

目的：调查2007-2010年鲍曼不动杆菌感染分布及临床分离株对常用抗茵药物耐药率的变迁,为临床合理使用抗鲍曼不动杆菌药物提供依据.方法：收集2007-2010年广州市第一人民医院住院患者临床标本分离出的1608株,了解鲍曼不动杆菌株分布及耐药情况,进行统计分析.药敏试验采用K-B纸片扩散法.结果：鲍曼不动杆菌对常用抗茵药物的耐药率从2007-2009有普遍性逐年增高的趋势,2010年较2009年有所下降,但较2007-2008年均高.治疗鲍曼不动杆菌的常用抗生素碳青霉烯类等敏感率在2007-2008年仍较高,达94％以上,但2009年明显下降,仅62.6％,2010年有所回升,为85.5％；对美罗培南的敏感率2007-2008年为100％,但在2009年突然降至44.4％；氨苄西林/舒巴坦的耐药率也呈现逐年上升,至2009年到高峰（46.7％）,2010年有所下降（31.6％）,仍然高于2007-2008年.在对头孢他啶耐药率逐年上升在2009高达50.5％,敏感率仅39.1％,2010年其耐药率有所下降,仍达50.3％,敏感率回升至45.8％；环丙沙星耐药率也呈现逐年上升,至2009年到高峰（40.2％）,2010年有所下降（38.9％）,仍然高于2007-2008年；对哌拉西林他唑巴坦、妥布霉素耐药率相对较低,但逐年呈现上升趋势,其中哌拉西林他唑巴坦耐药率分别为1.8％、9.7％、13.9％、14.8％,而阿米卡星的耐药率分别为4.5％、4.5％、16.5％、2.9％.结论：鲍曼不动杆菌是医院感染常见条件致病菌,其耐药问题已十分突出,应加强对多药耐药菌的监测和管理、合理使用抗菌药物,预防医院感染发生.

Infections with Acinetobacter baumannii and evolving prevalence of drug resistance between 2007 and 2010

Objective：To investigate the infections with Acinetobaeter baumannii and evolving prevalence of resistance to common antibiotics among clinically isolated strains between 2007 and 2010, so as to provide evidences for rational use of antibiotics. Methods： We analyzed the distribution and drug resistance of Aeinetobacter baumannii strains isolated from patients in Guangzhou First Municipal People＇ s Hospital between 2007 and 2010. Drug susceptibility test was performed by Kirby-Bauer method. Results： The rate of drug resistance to common antibacterial agents in Acinetobaeter baumannii was constantly on the rise from 2007 to 2009. This figure appeared somewhat lowered in 2010 than in 2009 ,but was still higher than those in 2007 and 2008. The rate of sensitivity to carbapenems was over 94% in 2007 and 2008 ,then declined to 62.6% in 2009, and rebounded to 85.5% in 2010. The rate of sensitivity to meropenem was 100% in 2007 and 2008, but abruptly decreased to 44.4% in 2009. Resistance to Ampicillin/Sulbactam was increasing over the years,peaked in 2009 （46.7%）, and decreased to 31.6% in 2010 but was still higher than those during 2007 -2008. Resistance to Ceftazidime increased to reach 50.5% with a sensitivity rate as low as 39.1% in 2009, and slightly declined to 50.3% with a sensitivity rate of 45.8% in 2010. Resistance to Ciprofloxacin was also ascending until a peak in 2009 （40.2%） ,and decreased to 38.9% in 2010 but was still higher than those during 2007 -2008. The resistance rates to Piperacillin/Tazobactam and Tobramycin, although low, were also increasing year by year, turning out to be 1.8% ,9.7%, 13.9% and 14.8%, respectively, for Piperacillin/Tazobactam; 4.5% ,4.5%, 16. 5% and 2. 9%, respectively, for Amikacin. Conclusion： Acinetobacter baumannii is one of common opportunistic pathogens for nosocomial infections. The conspicuously urging issue of drug resistance in this pathogen should warrant enhanced monitoring of insusceptible strains and rational use of antibiotics for prevention of nosocomial infections.