鲍曼不动杆菌耐药性变迁分析及临床对策

目的了解鲍曼不动杆菌(ABA)感染的菌群分布及其对抗菌药物耐药性的变迁趋势,为临床抗感染的预防、诊断、治疗及合理应用抗菌药物提供实验室依据。方法回顾性分析2011年1月至2014年12月本院临床送检的各类标本中分离的ABA的分布及耐药状况,使用VITEK2compact全自动细菌分析仪鉴定菌株及药敏试验,并对其进行统计分析。结果4年间从各类标本中共分离出病原菌7 136株,其中ABA 300株,分离率为4.2%,多药耐药鲍曼不动杆菌(MDR-AB)117株,分离率为39.0%;泛耐药鲍曼不动杆菌(PDR-AB)13株,分离率为4.3%,分离率总体呈上升趋势。ABA临床分布以ICU为主(31.7%),其次为呼吸科(29.3%),其他科室散在分布。感染分布以呼吸道标本为主,其次为分泌物,分别占89.7%和4.3%。ABA对常用抗菌药物的耐药率大部分在40%以上,对青霉素类、头孢菌素和β-内酰胺类抗菌药物均表现为较高耐药性。对丁胺卡那霉素的耐药率最低(3.0%),对头孢替坦和头孢呋辛钠完全耐药(100%)。结论 ABA对多种抗菌药物产生了较高的耐药性,并且多药耐药及泛耐药现象比较严重,应加强其耐药性的动态监测,规范合理应用抗菌药物,严格无菌操作,控制及延缓MDR-AB及PDR-AB的产生,预防和控制ABA的感染与暴发流行。

Analysis on drug resistance change of Acinetobacter baumannii and clinical countermeasures

Objective To understand the flora distribution and the change trend of antimicrobial drug resist‐ance of Acinetobacter baumannii (ABA) to provide the experimental basis for clinical prevention ,diagnosis ,treatment and reasonable application of antimicrobial agents in clinical anti‐infection .Methods The distribution and drug resist‐ance situation of ABA isolated from the various kinds of clinically submitted specimens in our hospital from January 2011 to December 2014 were performed the retrospective analysis .The VITEK2 compact automatic identification in‐strument was used to identify the bacterial strains and conduct the drug susceptibility test .The results were statisti‐cally analyzed .Results Among 7 136 strains of pathogenic bacteria were isolated from the various kinds of specimens during these 4 years ,in which 300 strains were ABA with the isolation rate of 4 .2% ,117 strains were multi‐drug re‐sistant ABA (MDR‐AB) ,the separation rate was 39 .0% ,13 strains were pan‐drug resistant ABA (PDR‐AB) ,the separation rate was 4 .3% ,the separation rate showed the upward trend as a whole .The ABA clinical distribution was dominated by ICU (31 .7% ) ,followed by the respiration department (29 .3% ) ,and the scattered distribution was in other departments .The infection distribution was mainly in respiratory tract specimens ,followed by the secretion specimens ,accounting for 89 .7% and 4 .3% respectively .Most of resistance rates of ABA to commonly used antimi‐crobial agents were more than 40% ,ABA showed the higher resistance to penicillins ,cephalosporin and beta lactam antimicrobial agents .The resistance rate to amikacin was lowest (3 .0% ) and ABA was completely resistant (100% ) to cefotetan and cefuroxime sodium .Conclusion ABA generates higher resistance to many kinds of antimicrobial a‐gents ,moreover the multi‐drug resistant and pan‐drug resistant phenomena are serious ,so the dynamic monitoring its drug resistance should be strengthened ,the rational use of antimicrobial drugs should be standardized ,the aseptic op‐eration should be strictly implemented for controlling and delaying the generation of multi‐drug resistant and pan‐drug resistant strains ,preventing and controlling the infection and epidemic outbreak of ABA .