耐碳青霉烯类鲍曼不动杆菌临床分布及耐药谱动态观察  

Distribution characteristics and dynamic observation of antimicrobial resistant spectrum of carbapenem-resistant Acinetobacter baumannii

作　　者：鲍群丽[1] 汪宏良[1] 柯俊[1] 

机构地区：[1]黄石市中心医院.湖北理工学院附属医院,湖北黄石435000

出　　处：《中国感染控制杂志》2015年第5期311-313,316,共4页Chinese Journal of Infection Control

摘　　要：目的探讨耐碳青霉烯类鲍曼不动杆菌(CRAB)临床分布特点与耐药情况,为临床合理使用抗菌药物、CRAB感染的治疗及其医院感染的防控提供参考依据。方法回顾性分析2009年1月—2013年12月临床标本分离的CRAB临床资料,应用WHONET5.5软件统计其标本分布和耐药情况。结果 5年共分离鲍曼不动杆菌(AB)标本888株,检出CRAB421株,检出率为47.4%,其中2011、2012和2013年检出率均在50.0%左右;标本来源以痰为主,占73.4%;科室分布以重症监护室(ICU)为主,占61.3%,其次是神经外科病房,为12.4%。CRAB呈现高度耐药性,除头孢噻肟和头孢曲松外,CRAB对检测的其他抗菌药物(头孢他啶、头孢吡肟、头孢哌酮/舒巴坦、氨曲南、亚胺培南、阿米卡星、庆大霉素、米诺环素、氯霉素、左氧氟沙星、环丙沙星、复方磺胺甲口恶唑)耐药率均高于非CRAB,差异均有统计学意义(均P≤0.01);5年来对头孢哌酮/舒巴坦耐药率最低(<15%),其次是米诺环素,对其余抗菌药物耐药率多>80.0%。结论应继续加强CRAB监测,重点关注ICU及呼吸系统医院感染的预防控制。Objective To investigate the distribution characteristics and antimicrobial resistance of carbapenem- resistantacinetobacter baumannii （CRAB）, and to guide effective clinical prevention and rational antimicrobial use. Methods Data about clinically isolated CRAB between January 2009 and December 2013 were analyzed retrospec- tively, distribution and antimicrobial resistance were analyzed by WHONET 5.5 software. Results A total of 888 Acinetobacter baumannii strains were isolated,421 of which were CRAB, the isolation rate was 47.4%, the isola- tion rates in 2011, 2012 and 2013 were all about 50.0% ; CRAB strains were mainly isolated from sputum （73.4%） and mostly distributed in intensive care unit （ICU） （61. 3 %）, followed by neurosurgery department （ 12.4% ）. CRAB presented highly antimicrobial resistance. Except cefotaxime and cefatriaxone, resistant rates of CRAB to the other detected antimierobial agents（eeftazidime, cefepime, cefoperazone/ sulbactam,aztreonam, imipenem, amika- ein, gentamyein, minoeycline, chloramphenicol, levofloxacin, ciprofloxaein, and compound sulfamethoxazole） were all higher than non-CRAB isolates（ all P≤0.01）, Compared with non-CRAB isolates, The resistant rate of CRAB to eefoperazone/sulbactam was the lowest（〈15 %）, followed by minocycline, resistant rates to other antimierobial agents were all 〉80.0%. Conclusion Surveillance of CRAB should be further strengthened. It is necessary to fo- cus on the control and prevention of healthcare-associated infection in ICU patients and respiratory system.

关 键 词：鲍曼不动杆菌 碳青霉烯酶 碳青霉烯类抗生素 耐碳青霉烯类鲍曼不动杆菌 抗药性 微生物 医院感染 

分 类 号：R378[医药卫生—病原生物学]