780株鲍曼不动杆菌的临床分布及药敏结果  

Clinical distribution and drug resistance of 780 strains of Acinetobacter baumanii

作　　者：谢晓英[1] 刘晓强[1] 代鑫露 黄松音[1] 李红玉[1] 

机构地区：[1]中山大学孙逸仙纪念医院,广东广州510120

出　　处：《中国微生态学杂志》2016年第2期174-176,180,共4页Chinese Journal of Microecology

基　　金：广东省科技社会发展项目(2012B031800042)

摘　　要：目的了解鲍曼不动杆菌的分布及耐药率,为临床合理用药提供参考。方法对2011年1月至2013年12月从各类临床标本中分离的鲍曼不动杆菌进行统计分析。应用VITEK-2全自动细菌鉴定药敏仪进行菌株鉴定及药敏试验,参照2013年美国临床实验室标准化委员会（CLSI）标准判断药敏结果,以WHONET 5.6及SPSS 13.0统计软件进行数据分析。结果共检出780株鲍曼不动杆菌,科室分布居前的有重症监护室、呼吸科、皮肤科、胸外科及神经科,标本来源构成比居前的依次是痰液、分泌物及血液。其中共检出耐碳青霉烯类鲍曼不动杆菌（CRAB）120株,占15.38%,重症监护室的CRAB检出率显著高于其他科室（χ2=12.147,P〈0.05）;痰液来源的CRAB分离率比其余标本类型高（χ2=4.047,P〈0.05）。共检出泛耐药鲍曼不动杆菌（XDRAB）26株,占3.33%,其中各科室及各标本来源间差异均无统计学意义（χ2=0.692,P〉0.05;χ2=1.008,P〉0.05）。除了对一代头孢菌素、氨苄西林等的天然耐药,鲍曼不动杆菌对二代头孢菌素、氨曲南及呋喃妥因耐药严重,均超过90.0%;其余的抗生素耐药率均在30.0%~50.0%,其中碳青霉烯类耐药率也达30.0%以上;左旋氧氟沙星的耐药率最低,为29.7%。重症监护室分离的鲍曼不动杆菌耐药最为严重,对以上药物耐药率均超过50.0%。结论鲍曼不动杆菌感染的标本来源与分离科室不同,CRAB检出率有差别,耐药率有较大差异,临床医师应根据药敏结果选择使用抗菌药物。Objective To learn the clinical distribution and drug resistance of Acinetobacter baumanii（Ab）in our hospital,and provide the basis for clinical use of antimicrobial drugs.Methods Ab strains clinically isolated from Jan 2011 to Dec 2013 in Sun Yat-Sen Memorial Hospital were subject to analysis.Bacteria identification and drug sensitivity were detected by VITEK-2automatic bacteria identification system,and the results of antimicrobial susceptibility were determined according to CLSI 2013 criteria.All the data were analyzed by WHONET 5.6and SPSS 13.0software.Results 780 strains of Ab were detected,which were mainly from intensive care unit,respiratory department,dermatological department,cardiothoracic surgery department and neurology department.The main sample sources were sputum,secretion and blood.120 strains of CRAB were detected,with the detection rate in ICU being the highest（χ2=12.147,P〈0.05）;most of the CRAB was from sputum（χ2=4.047,P〈0.05）.26 strains of XDRAB were detected,with no significant differences between the departments and specimen types（χ2=0.692,P〉0.05;χ2=1.008,P〉0.05）.In addition to the natural resistance to first-generation Cephalosporins and Ampicillin,the resistance rates of Ab to second-generation Cephalosporins,Aztreonam and Nitrofurantoin were above90.0%;the resistance rates to other antibiotics including Carbapenem were between 30.0% and 50.0%.The lowest resistance rate was to Levoflexofloxacin（29.7%）.The Ab from ICU was the most drug resistant,whose resistance rates were all above 50.0%.Conclusion The detection rate and resistance of Ab including CRAB are different between departments.Clinicians should use antimicrobial drugs rationally.

关 键 词：鲍曼不动杆菌 耐药性 抗生素 检出率 

分 类 号：R446.51[医药卫生—诊断学]