区域性三级综合医院鲍氏不动杆菌耐药趋势及流行病学研究  

Trend of drug resistance and epidemiology of Acinetobacter baumannii strains in regional tertiary general hospitals

作　　者：孙吉花[1] 纪冰[2] 张学美[3] 邱会芬[1] 张霞[1] 张洁[1] 赵爱荣[4] 

机构地区：[1]滨州医学院附属医院院感办,山东滨州256603 [2]滨州医学院附属医院微生物室,山东滨州256603 [3]滨州市妇幼保健院手术室,山东滨州256603 [4]滨州市妇幼保健院药学部,山东滨州256603

出　　处：《中华医院感染学杂志》2016年第18期4104-4106,共3页Chinese Journal of Nosocomiology

基　　金：山东省医药卫生科技发展计划(2015WS0491);滨州市科技发展计划(2013ZC1802;2013ZC1714;2013ZC1711);医院管理创新项目(FY2014GL06;FY2016GL02)

摘　　要：目的研究区域性三级综合医院鲍氏不动杆菌(AB)耐药性、分布以及分子流行特征,为医院长期监测及预防控制暴发流行奠定基础。方法收集2014年1-12月滨州市3所三级综合医院AB菌株683株,采用纸片扩散法检测耐药率,应用WHONET5.5统计软件进行分析;随机选取耐亚胺培南和(或)美罗培南AB菌株27株进行基因检测,应用ERIC-PCR法分析菌株同源关系。结果 AB分离率为5.50%,多药耐药AB(MDRAB)分离率为63.10%;耐药率最高为哌拉西林(62.08%),最低为米诺环素(21.08%),其次较低为头孢哌酮/舒巴坦(37.04%);主要碳青霉烯酶基因为OXA-23、OXA-24、OXA-51、OXA-64;存在4个克隆株分布于3所医院,A型是主要流行克隆株。结论滨州市区域性MDRAB分离率高,且耐药现象严重,提示头孢哌酮/舒巴坦和米诺环素可慎重作为MDRAB感染的经验用药;检测OXA-51可辅助快速鉴定AB;医院内存在不同型AB菌株播散以及同一克隆株在医院之间散在流行播散,应引起高度重视。OBJECTIVE To explore the drug resistance,distribution,and molecular epidemiological characteristics of Acinetobacter baumannii strains in tertiary general hospitals so as to provide guidance for long-term surveillance and prevention of outbreak and prevalence.METHODS A total of 683 strains of A.baumannii were isolated from 3tertiary general hospitals from Jan 2014 to Dec 2014,then the drug resistance rates were detected by using disk diffusion method,and the statistical analysis was performed with the use of WHONET5.5software.Totally 27 strains of imipenem-resistant or meropenem-resistant A.baumannii were randomly selected for the detection of genes,and the homology of the strains was analyzed by means of ERIC-PCR.RESULTS The isolation rate of A.baumannii strains was 5.50%,and the isolation rate of multidrug-resistant A.baumannii（MDRAB）strains was 63.10%.The drug resistance rate to piperacillin was the highest（62.08%）,the drug resistance rate to minocycline was the lowest（21.08%）,and the drug resistance rate to cefoperazone-sulbactam was 37.04%.The major carbapenemase genes were as follows：OXA-23,OXA-24,OXA-51,OXA-64;there were 4clones which distributed in 3hospitals,and the type A was the most prevalent.CONCLUSION The isolation rate of MDRAB strains is high in Binzhou area;the strains are highly drug-resistant,indicating that cefoperazone-sulbactam and minocycline can be carefully chosen for empirical medication for the MDRAB infection.The detection of OXA-51 may facilitate the rapid identification of the A.baumannii strains.The different types of A.baumannii strains scatter in the hospitals,and the same clone strains are prevalent and spread among the hospitals,which should be attached great importance to.

关 键 词：区域性 鲍氏不动杆菌 碳青霉烯酶 多药耐药菌 

分 类 号：R378[医药卫生—病原生物学]