不同标本来源鲍氏不动杆菌耐药性变迁  

Change of antimicrobial resistance of Acinetobacter baumanii isolated from different specimens

作　　者：侯铁英[1] 廖亚龙[1] 黄德弘[2] 张莉滟[1] 陈柳勤[1] 王媚[1] 

机构地区：[1]广东省人民医院广东省医学科学院医院感染控制医学部,广东广州510080 [2]广州市中医医院,广东广州510130

出　　处：《中华医院感染学杂志》2012年第21期4879-4881,共3页Chinese Journal of Nosocomiology

摘　　要：目的分析医院2008-2010年不同标本来源的鲍氏不动杆菌耐药性变迁,指导临床合理用药。方法收集2008年1月-2010年12月非重复的鲍氏不动杆菌,重新鉴定复核,药敏结果采用CLSI 2011年标准判断,用WHONET5.4软件进行分析。结果 2008-2010年共分离到非重复鲍氏不动杆菌1147株,主要分离自呼吸道标本,3年来自支气管冲洗液的菌株构成比逐年下降,由30.6%降至17.6%,来自尿液的菌株构成比逐年上升,由1.0%上升至4.9%,分离自痰液的菌株构成比无显著性变化;不同标本分离的鲍氏不动杆菌对抗菌药物的敏感性差异明显;3年临床分离的鲍氏不动杆菌对头孢哌酮/舒巴坦的敏感率下降明显,由66.4%降至47.1%;鲍氏不动杆菌对庆大霉素、妥布霉素、环丙沙星、左氧氟沙星、磺胺甲噁唑/甲氧苄啶的总体敏感率均出现不同程度的上升(P<0.05)。结论鲍氏不动杆菌分离部位构成比的变化可导致其对抗菌药物总体敏感率的改变,因此细菌的耐药监测数据应细化至不同分离部位,临床用药需考虑其标本来源。OBJECTIVE To investigate the distribution and the change of antibiotic resistance of Acinetobacter baumanii isolated from the hospital from 2008 to 2010,and to guide the clinical reasonable medication.METHODS All consecutive and non-repetitive A.baumanii were collected from Jan 2008 to Dec 2010 in the hospital.After re-identification,the interpretive results were determined by CLSI.The resistance surveillance data were studied by using the ＂WHONET 5.4＂ software.RESULTS Totally 1147 strains of non-repetitive A.baumanii were isolated,most of them were isolated from respiratory tract specimens.The constituent ratio of the strains isolated from bronchial flushing fluid in the recent three years decreased from 30.6% to 17.6%,while the constituent ratio of the strains from the urine increased year by year,1.0% up to 4.9%,and there was no significant change in the constituent ratio of the strains isolated from sputum.The A.baumannii strains isolated from different specimens varied significantly in the drug susceptibility.The drug susceptibility rates of A.baumannii strains to cefoperazone/sulbactam decreased from 66.4% to 47.1% in the recent three years,yet the overall susceptibility rates of A.baumannii to gentamicin,tobramycin,ciprofloxacin,levofloxacin,and sulfamethoxazole/trimethoprim showed an increase in varying degrees（P0.05）.CONCLUSION The change of constituent ratio of the sites from which A.baumannii were isolated may lead to the change of the overall susceptibility rate to antibiotics,thus the monitoring data of bacterial resistance should be detailed,and the clinical medication should be performed in accordance with the specimens sources.

关 键 词：标本 耐药性 鲍氏不动杆菌 

分 类 号：R378[医药卫生—病原生物学]