多重耐药鲍曼不动杆菌对替加环素耐药状况分析

目的 了解多重耐药鲍曼不动杆菌对临床常用抗生素及新药替加环素的耐药状况.方法 收集2008-2009年浙江省4所教学医院的602株临床分离鲍曼不动杆菌,采用琼脂稀释法检测其对13种临床常用抗生素的敏感性,以及对多黏菌素B和替加环素的敏感性.同时,采用PFGE技术对24株多重耐药鲍曼不动杆菌进行同源性分析,以确定菌株间的亲缘关系.结果 浙江省4家教学医院2008-2009年分离的鲍曼不动杆菌主要来自于呼吸道标本,2009年达到277株(86.0%),血液标本数量从2008年的15株(5.4%)下降到2009年的5株(1.5%),而其他标本无明显变化.鲍曼不动杆菌对临床常用的13种抗生素均有不同程度的耐药,耐药率35.0%～85.0%.与2008年相比,除左氧氟沙星和妥布霉素耐药率分别下降0.9%和9.0%以外,2009年其余抗生素耐药率均有不同程度地上升,头孢曲松和头孢吡肟耐药率增加了近10.0%,对碳青霉烯类抗生素亚胺培南和美罗培南的耐药率分别达到74.2%(239/602)和70.8%(228/602).鲍曼不动杆菌对替加环素显示了很高的耐药率,耐药率达到78.9%(475/602),而多黏菌素B耐药率仅为3.7%(22/602).PFGE分型显示2008-2009年24株鲍曼不动杆菌有6个克隆型,其中A型最常见,占50%.结论 鲍曼不动杆菌对替加环素的耐药加大了院内感染控制的难度,临床应加强控制,防止多重耐药菌的传播.

Abstract：

Objective To investigate the resistance of Acinetobacter baumannii to clinical common antibiotics and new drug tigecycline. Methods Six hundred and two Acinetobacter baumannii isolates were collected from 2008 to 2009 in four teaching hospitals in Zhejiang province. Agar dilution method was used to detect the resistance of 13 clinical commom antibiotics, polymyxin B and tigecycline. Homology analysis of 24 multi-drug resistant Acinetobacter baumannii strains was used to investigate the relationship of each strain with the method of pulsed field gel electrophoresis. Results From 2008 to 2009, the Acinetobacter baumannii isolates of four teaching hospitals in Zhejiang province were mainly isolated from respiratory specimens with the number of 277 (86.0%) strains in 2009, the number of blood samples decreased from 15 (5.4%) strains in 2008 to 5 ( 1.5% ) strains in 2009, and there were no obvious change in other specimens. Acinetobacter baumannii strains were resistant to 13 clinical common antibiotics at different degree, fluctuated from 35.0% to 85.0%. Compared with the resistance in 2008, levofloxacin and tobramyxin decreased 0. 9% and 9.0% in 2009, respectively. However, the resistance of other antibiotics increased at different degree, the resistance of ceftriaxone and cefepime increased about 10.0%, and the resistance of imipenem and meropenem increased to 74.2% (239/602) and 70.8% (228/602) in 2009,respectively. Acinetobacter baumannii showed high resistance to tigecycline with the percent of 78.9% (475/602), while it was only 3.7% (22/602) for polymyxin B. There were six cloning types among the 24 Acinetobacter baumannii isolates, and the most common type was type A with the percent of 50%.Conclusions The resistance of tigecycline makes the situation of nosocomial infectious more serious. It is necessary to control the transmission of multi-drug resistant Acinetobacter baumannii immediately.

The resistance of multi-drug resistant Acinetobacter baumannii to tigecycline

Objective To investigate the resistance of Acinetobacter baumannii to clinical common antibiotics and new drug tigecycline. Methods Six hundred and two Acinetobacter baumannii isolates were collected from 2008 to 2009 in four teaching hospitals in Zhejiang province. Agar dilution method was used to detect the resistance of 13 clinical commom antibiotics, polymyxin B and tigecycline. Homology analysis of 24 multi-drug resistant Acinetobacter baumannii strains was used to investigate the relationship of each strain with the method of pulsed field gel electrophoresis. Results From 2008 to 2009, the Acinetobacter baumannii isolates of four teaching hospitals in Zhejiang province were mainly isolated from respiratory specimens with the number of 277 (86.0%) strains in 2009, the number of blood samples decreased from 15 (5.4%) strains in 2008 to 5 ( 1.5% ) strains in 2009, and there were no obvious change in other specimens. Acinetobacter baumannii strains were resistant to 13 clinical common antibiotics at different degree, fluctuated from 35.0% to 85.0%. Compared with the resistance in 2008, levofloxacin and tobramyxin decreased 0. 9% and 9.0% in 2009, respectively. However, the resistance of other antibiotics increased at different degree, the resistance of ceftriaxone and cefepime increased about 10.0%, and the resistance of imipenem and meropenem increased to 74.2% (239/602) and 70.8% (228/602) in 2009,respectively. Acinetobacter baumannii showed high resistance to tigecycline with the percent of 78.9% (475/602), while it was only 3.7% (22/602) for polymyxin B. There were six cloning types among the 24 Acinetobacter baumannii isolates, and the most common type was type A with the percent of 50%.Conclusions The resistance of tigecycline makes the situation of nosocomial infectious more serious. It is necessary to control the transmission of multi-drug resistant Acinetobacter baumannii immediately.