2004-2008年重症监护病房鲍氏不动杆菌耐药性变迁  

Variance of Drug-resistance in Acinetobacter baumannii Isolated from ICU 2004-2008

作　　者：周东升[1] 潘晓龙[1] 

机构地区：[1]铜陵市人民医院检验科,安徽铜陵244000

出　　处：《中华医院感染学杂志》2010年第16期2487-2490,共4页Chinese Journal of Nosocomiology

基　　金：安徽省自然科学基金(050430804);安徽省铜陵市卫生局科研课题资助项目(科研〔2009〕10)

摘　　要：目的了解5年医院重症监护病房(ICU)鲍氏不动杆菌对临床常用抗菌药物的耐药性变迁情况,为规范抗菌药物使用、防止耐药株流行提供依据。方法采用纸片扩散(K-B)法检测医院ICU2004-2008年临床分离的277株鲍氏不动杆菌对亚胺培南等抗菌药物的敏感性,结果用WHONET5.3软件进行数据统计分析;三维试验法检测耐碳青酶烯类鲍氏不动杆菌产碳青酶烯酶表型情况。结果 5年中鲍氏不动杆菌均占据ICU病原菌分布首位;其对临床常用17种抗菌药物的耐药率总体呈逐年上升趋势,尤其是亚胺培南由2004年的100.0%敏感上升到2008年的36.2%耐药,此外耐药率上升较显著的还有:哌拉西林、哌拉西林/他唑巴坦、替卡西林/克拉维酸、头孢噻肟、头孢曲松、头孢哌酮/舒巴坦、头孢他啶、头孢吡肟、环丙沙星、氧氟沙星和阿米卡星,分别由2004年的39.3%、25.0%、25.0%、29.6%、28.6%、3.6%、39.3%、26.9%、46.4%、44.4%、28.6%上升到2008年的79.4%、71.0%、74.2%、75.4%、73.9%、30.9%、72.5%、72.5%、77.9%、88.2%、72.1%;所有耐碳青酶烯类鲍氏不动杆菌三维试验法检测产碳青酶烯酶表型试验均为阳性。结论 ICU鲍氏不动杆菌感染率高,5年对临床常用抗菌药物的耐药性显著增强,耐碳青酶烯类鲍氏不动杆菌在2008年有病区内暴发流行的可能,产碳青酶烯酶可能是其主要耐药机制。OBJECTIVE To investigate the variance of drug-resistance of Acinetobacter baumannii to commonly usedclinical antibiotics in intensive care unit （ICU） in the latest five years,to provide a theoretical basis in order to standardize the use of antibiotics and to prevent the prevalence of resistant strains.METHODS The drug resistance of 277 clinical isolates of A.baumannii from our ICU from 2004 to 2008 against imipenem and other kinds antibiotics was tested by disk diffusion method （K-B）.The results were performed the statistical analysis by 5.3 WHONET software;three-dimensional test method was applied to test carbapenem enzyme produced by carbapenem-resistant A.baumannii.RESULTS Among the 5 years,A.baumannii in our hospital occupied the first dominant position of ICU pathogens;overall,the resistance rate of A.baumannii to 17 kinds of commonly used clinical antibiotics of was increasing year by year;especially to imipenem,the sensitive rate decreased from 100% in 2004 to 36.2% in 2008.Additionally,the following drug resistance rates were more significant：piperacillin,piperacillin/tazobactam,ticarcillin/clavulanic acid,cefotaxime,ceftriaxone,cefoperazone/sulbactam,ceftazidime,cefepime,ciprofloxacin,ofloxacin and amikacin,their drug-sensitive rates decreased from 39.3%,25.0%,25.0%,29.6%,28.6%,3.6%,39.3%,26.9%,46.4%,44.4%,and 28.6% in 2004 to 79.4% 71.0%,74.2%,75.4%,73.9%,30.9%,72.5%,72.5%,77.9%,88.2 %,and 72.1% in 2008,respectively;three-dimensional test showed that all the carbapenem enzyme confirmed by phenotype tests was positive.CONCLUSIONThe infection rate ofA.baumanniiin the ICU of our hospital is high,its clinical resistance to commonly used antibiotics significantly increased in the past five years.The carbapenem-resistant A.baumannii in the regionin 2008 might cause the outbreak of epidemic infectious disease,Carbapenemenzyme-producing may be the main mechanismof its resistance.

关 键 词：鲍氏不动杆菌 重症监护病房 耐药监测 多药耐药 病原菌 抗药性 

分 类 号：R978.1[医药卫生—药品]