2018—2019年北京市海淀医院多重耐药鲍曼不动杆菌临床感染特点及耐药性分析

目的 分析北京市海淀医院多重耐药鲍曼不动杆菌（multidrug-resistant Acinetobacter baumannii，MDR-AB）临床感染的特点及耐药性，为临床用药提供一定的理论依据。方法 将北京市海淀医院2018年10月—2019年10月分离的178株鲍曼不动杆菌（Acinetobacter baumannii）作为研究对象，对其相关临床资料及体外药物敏感性试验结果进行分析。结果 鲍曼不动杆菌多重耐药率为46.6%，且97.6% MDR-AB为耐碳青霉烯鲍曼不动杆菌（CR-AB）。MDR-AB主要分离自高龄（>60岁）患者（86.7%）和重症监护室（ICU）患者（65.1%），且86.7% MDR-AB分离自痰液标本。MDR-AB对各种常用抗菌药物的耐药率明显高于普通鲍曼不动杆菌，差异具有统计学意义（P<0.05）；MDR-AB中同时耐碳青霉烯类、氟喹诺酮类、抗铜绿假单胞菌青霉素加酶抑制剂类、广谱头孢菌素类、氨基糖苷类、四环素类等抗菌药物的菌株的占比最高（39.8%）。结论 高龄和ICU患者是MDR-AB的主要易感人群，MDR-AB对各种常用抗菌药物的耐药率明显高于普通鲍曼不动杆菌，替加环素对MDR-AB的耐药率相对低于其他抗菌药物，临床应合理使用抗菌药防止MDR-AB的产生和传播。

Clinical infection characteristics and drug resistance of multidrug-resistant Acinetobacter baumannii in Beijing Haidian Hospital from 2018 to 2019

Objective To analyze the clinical infection characteristics and drug resistance of of multidrug-resistant Acinetobacter baumannii (MDR-AB), so as to provide evidence for clinical rational drug use. Methods The relative clinical data and in vitro drug sensitivity test results of 178 Acinetobacter baumannii strains isolated from Beijing Haidian Hospital from October 2018 to October 2019 were analyzed. Results The multidrug resistance rate of AB was 46.6% and 97.6% of MDR-AB were carbapenem resistant Acinetobacter baumannii (CR-AB). MDR-AB were mainly isolated from elderly patients (> 60 years old, 86.7%) and the patients in intensive care unit (ICU, 65.1%), and 86.7% of MDR-AB were isolated from sputum samples. The drug resistance rates of MDR-AB to commonly used antibiotics were significantly higher than that of AB (P<0.05). The MDR-AB that were resistant to carbapenems, fluoroquinolones, anti-pseudomonas aeruginosa penicillin-enzyme inhibitors, broad-spectrum cephalosporins, aminoglycosides and tetracyclines together accounted for the highest proportion (39.8%) among all the MDR-AB. Conclusion The elderly and the patients in ICU are the main susceptible population of MDR-AB. The drug resistance rate of MDR-AB to various commonly used antibiotics is significantly higher than that of AB. The drug resistance rate of tegacyclin to MDR-AB is relatively lower than that of other antibiotics. Antibiotics should be used rationally to prevent the emergence and spread of MDR-AB.