某院2009-2013年鲍曼不动杆菌临床分布及耐药性变迁

目的对2009—2013年鲍曼不动杆菌(AB)临床分布及耐药性变迁进行分析,以期指导临床合理用药,降低医院感染率。方法某院2009年1月—2013年12月住院及门诊患者分离AB919株,采用回顾性的方法对其标本和病区来源,以及耐药性变迁进行分析。结果 2009—2013年共分离病原菌10 273株,各年度AB占分离病原菌的构成比分别为7.98%(93株)、11.31%(155株)、10.22%(185株)、7.73%(217株)和8.62%(269株);而耐亚胺培南鲍曼不动杆菌(IRAB)占AB的构成比分别24.73%、38.06%、71.89%、64.52%和86.99%。标本来源主要为痰液,占83.68%;病区来源主要为重症监护室(ICU,39.28%)、神经内科(20.78%)和呼吸内科(8.60%)。2009—2013年AB对大多数抗菌药物的耐药率有上升趋势,对亚胺培南和哌拉西林/他唑巴坦的耐药率由2009年的24.73%和4.44%,增至2013年的86.99%和86.25%;对复方磺胺甲口恶唑的耐药率由2009年的91.30%降至2013年的27.14%;2013年,除对阿米卡星(20.82%)和复方磺胺甲口恶唑(27.14%)的耐药率较低外,AB对其他11种抗菌药物的耐药率均83.64%。结论该院AB分离率高,标本和病区来源主要为痰液和ICU;AB耐药率高,应加强预防和控制AB的医院感染和传播。

Clinical distribution and change in drug resistance of Acinetobacter baumannii in a hospital in 2009-2013

ObjectiveTo analyze clinical distribution and change in drug resistance of Acinetobacter baumannii (A. baumannii) in 2009-2013, guide clinical rational antimicrobial  use， and reduce healthcare associated infection rate. Methods919 A. baumannii isolates were isolated from inpatients and outpatients in a hospital between January 2009 and December 2013, specimen and department sources, as well as change in drug resistance of A. baumannii were analyzed. ResultsA total of 10 273 pathogens were isolated from 2009  to  2013,  the constituent ratio of A. baumannii in each year was 7.98%（n=93）,11.31%（n=155）,10.22%（n=185）,7.73%（n=217）, and 8.62%（n=269）respectively；the constituent ratio of imipenem resistant A. baumannii was 24.73%,38.06%,71.89%,64.52%, and 86.99% respectively；the main specimen source was sputum (83.68%); the major department sources were intensive care unit(ICU, 39.28%),  department of neurology (20.78%）， and department of respiratory  medicine（8.60%）. The resistant rate of A. baumannii to most antimicrobial agents increased, the resistant rates to imipenem and piperacillin / tazobactam  increased from 24.73% and 4.44% in 2009 to 86.99% and 86.25% in 2013 respectively; resistant rate to sulphamethoxazole/trimethoprim decreased from 91.30% in 2009 to 27.14% in 2013; in 2013, except resistant rates to amikacin and sulphamethoxazole/trimethoprim were low (20.82% and 27.14% respectively), resistant rates to the other 11 kinds of antimicrobial agents were all ＞83.64%.  ConclusionThe isolation rate of A. baumannii  is high in this hospital, the main specimen source is sputum, the main department source is ICU; antimicrobial resistant rate of A. baumannii is high, prevention and control of infection and transmission of A. baumannii should be strengthened.