多重耐药鲍曼不动杆菌的耐药率演变及临床特征  

Resistance variation trend and clinical character of multi-drug resistant Acinetobacter baumannii

作　　者：陈浩浩[1] 蔡晓锐[2] 汤丹灵[1] 蔡德[1] 魏敦灿[1] 林芸[3] CHEN Haohao;CAI Xiaorui;TANG Danling;CAI De;WEI Duncan;LIN Yun(Department of Pharmacy,the First Affiliated Hospital of Shantou University Medical College,Guangdong Province,Shantou 515041,China;Department of Pharmacy,Cancer Hospital of Shantou University Medical College,Guang-dong Province,Shantou 515041,China;Department of Pharmacy,Shantou Central Hospital,Guangdong Province,Shantou 515041,China)

机构地区：[1]汕头大学医学院第一附属医院药剂科,广东汕头515041 [2]汕头大学医学院附属肿瘤医院药剂科,广东汕头515041 [3]广东省汕头市中心医院药剂科,广东汕头515041

出　　处：《中国医药导报》2018年第20期163-167,共5页China Medical Herald

基　　金：广东省汕头市医疗科技计划项目(20150406)

摘　　要：目的分析汕头大学医学院第一附属医院(以下简称"我院")住院患者多重耐药鲍曼不动杆菌的耐药率演变情况,为其预防和治疗提供参考。方法采用回顾性调查分析方法,收集我院2013~2016年多重耐药鲍曼不动杆菌感染住院患者902例的临床资料,包括性别、年龄、科室、临床诊断和药敏检测结果等,采用χ2检验和Pearson统计方法对结果进行分析。结果患者男女比例约7∶3,年龄以中老年患者为主,其中>65岁占40%以上,18~65岁占50%左右;送检标本以痰为主,占80%以上,其次是血液、尿液和分泌物,这3类合计占10%左右;科室分布以ICU、神经外科、神经内科为主,其中ICU和神经外科的构成比呈下降趋势,从2013~2016年的构成比分别从43.61%和36.84%下降为23.05%和25.15%,神经内科、呼吸内科和新生儿科的构成比有所上升,分别从2013年的6.77%、4.51%和0.75%到2016年升高至10.48%、7.49%和5.69%;分离得到的多重耐药鲍曼不动杆菌对替加环素、多黏菌素B的4年平均耐药率在10%以下,对左旋氧氟沙星和头孢哌酮/舒巴坦耐药率接近50%,对被分析的其他抗菌药物的耐药率均超过50%,有共10个药物超过80%;多重耐药鲍曼不动杆菌占比逐年上升,变化趋势明显(P<0.05)。Pearson相关分析结果显示,头孢曲松、头孢吡肟、庆大霉素、妥布霉素、环丙沙星等药物耐药率与亚胺培南的耐药率变化趋势呈高度正相关(P<0.05)。结论多重耐药鲍曼不动杆菌主要集中在ICU、神经外科、神经内科,且对常用抗菌药物的耐药率高,应加强抗菌药物的合理应用和多重耐药菌的管理。Objective To analyze Lhe resisLance Lrend of mulLi-drug resisLanL Acinetobacter baumanii(MDR-AB)of Lhe inpaLienLs in Lhe FirsL AffiliaLed HospiLal of ShanLou UniversiLy Medical College(野our hospiLal冶for shorL),in order Lo provide reference for clinical LreaLmenL.Methods ReLrospecLive analysis was used for Lhis sLudy.The clinical daLa of 902 inpaLienLs wiLh MDR-AB infecLion from 2013 Lo 2016 in our hospiLal were collecLed.The clinical daLa such as sex,age,deparLmenL,clinical diagnosis and drug sensiLiviLy LesL resulLs were collecLed.Chi-square LesL and Pearson were used for sLaLisLical analysis.Results The proporLion of male Lo female was abouL 7 Lo 3.MajoriLy of Lhe cases were mid-dle-aged and aged,of which over 40%were>65 years old,and abouL 50%were 18-65 years old.SpuLum specimen was mainly,which accounLed for over 80%.AbouL 10%.of Lhe LoLal specimen were blood,urine and secreLions.The cases mainly disLribuLed in DeparLmenL of ICU,Neurosurgery and Neurology.The proporLion of DeparLmenL of ICU and Neurosurgery showed a decreasing Lrend,during Lhe period from 2013 Lo 2016,whose proporLion were reduced from 43.61%and 36.84%Lo 23.05%and 25.15%respec-Lively.On Lhe conLrary,Lhe proporLion of DeparLmenL of Neurology,RespiraLory Medicine and NeonaLes showed increasingly,whose proporLion were increased from 6.77%,4.51%and 0.75%Lo 10.48%,7.49%and 5.69%from 2013 to 2016.The average resistance rate of MDR-AB to Tigecycline and Polymyxin B were below 10%,to Lev-ofloxacin and Cefoperazone/Sulbactan were close to 50%,to the other antibacterials which were analyzed in this study were above 50%,more seriously,ten of these drugs whose resistance were over 80%.In addition,the proportion of MDR-AB increased significantly(P<0.05).The results of Pearson correlation analysis showed that resistance rates of Ceftriaxone,Cefepime,Gentamycin,Tobramycin and Ciprofloxacin were highly positive correlated with the trend of Imipenem resistance(P<0.05).Conclusion The isolated MDR-AB are mainly located in Department of ICU,Neuro-surgery and

关 键 词：鲍曼不动杆菌 多重耐药 药物敏感性 合理用药 

分 类 号：R378[医药卫生—病原生物学]