医院感染鲍氏不动杆菌耐药分析及同源性研究  

Drug resistance and homology of Acinetobacter baumannii causing nosocomial infections

作　　者：宋志伟[1] 郏伊范[1] 沈伟伟[2] 潘晓[1] 张瑾[1] 

机构地区：[1]台州市立医院检验科,浙江台州318000 [2]台州市疾病预防控制中心微生物检验科,浙江台州318000

出　　处：《中华医院感染学杂志》2017年第13期2904-2907,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生研究计划基金资助项目(2013KY230)

摘　　要：目的了解鲍氏不动杆菌的分布和耐药情况,分析其同源性,为临床治疗提供依据。方法收集2014年1月-2016年12月临床分离的1489株鲍氏不动杆菌,采用VITEK-Compact全自动微生物分析系统进行鉴定及耐药分析,同时选取60株耐碳青霉烯类鲍氏不动杆菌(CRAB)进行同源性分析,使用SPSS18.0软件进行统计分析。结果 3年内临床住院患者检出病原菌13828株,其中有1489株鲍氏不动杆菌,分离率为10.8%;主要来自ICU;以痰液标本为主;头孢唑林、头孢曲松、氨曲南、呋喃妥因的耐药率均>95%;CRAB对阿莫西林/克拉维酸、哌拉西林/他唑巴坦、头孢吡肟、头孢哌酮/舒巴坦、庆大霉素、阿米卡星、左氧氟沙星、环丙沙星、妥布霉素、磺胺甲噁唑/甲氧苄啶、替加环素耐药率均高于碳青霉烯类药物敏感的鲍氏不动杆菌(CSAB),其差异有统计学意义(P<0.05);60株CRAB的同源性分析主要有6型,其中A型32株、B型7株、C型6株、D型7株、E型5株、G型3株。结论医院分离鲍氏不动杆菌集中分布在ICU和神经外科,其耐药性现象严重,存在着耐碳青霉烯类鲍氏不动杆菌A型克隆株的散播流行,应重视鲍氏不动杆菌感染的预防和监测。OBJECTIVE To investigate the distribution and drug resistance of Acinetobacter baumannii and analyze the homology so as to provide guidance for clinical treatment.METHODS A total of 1489 clinical A.baumannii isolates were collected from Jan 2014 to Dec 2016,then the strains were identified by using VITEK-Compact automatic microorganism analysis system,meanwhile,60 strains of carbapenem-resistant Acinetobacter baumannii（CRAB）were collected to analyze the homology,and the statistical analysis was performed with the use of SPSS18.0 software.RESULTS Totally 13828 strains of pathogens were isolated from clinical hospitalized patients in 3 years,of which 1489 were A.baumannii,with the isolation rate 10.8%.Most of the A.baumannii strains were isolated from ICU and sputum specimens.The drug resistance rates to cefazolin,ceftriaxone,aztreonam,and nitrofurantoin were more than 95%.The drug resistance rates of the CRAB strains were significantly higher than those of the carbapenem-sensitive Acinetobacter baumannii（CSAB）strains to amoxicillin-clavulanic acid,piperacillin-tazobactam,cefepime,cefoperazone-sulbactam,gentamicin,amikacin,levofloxacin,ciprofloxacin,tobramycin,sulfamethoxazole-rimethoprim,and tigecycline（P〈0.05）.The homological analysis showed that the 60 strains of CRAB belonged to 6 major types,including 32 strains of type A,7 strains of type B,6 strains of type C,7 strains of type D,5 strains of type E,and 3 strains of type G.CONCLUSION The A.baumannii strains are mainly isolated from ICU and neurosurgery department and are highly resistant to antibiotics,the type A CRAB clone strains are prevalent,and it is necessary to pay attention to the prevention and monitoring of the A.baumannii infection.

关 键 词：鲍氏不动杆菌 耐药性 同源性 

分 类 号：R378[医药卫生—病原生物学]