鲍曼不动杆菌临床分布及耐药性变迁分析  

Analysis of clinical distribution and drug resistance changes of Acinetobacter baumannii

作　　者：马晨[1] 韩丹[1] 张祎[1] 袁晶 雷金娥[1] 陈葳[1] MA Chen;HAN Dan;ZHANG Yi;YUAN Jing;LEI Jin'e;CHEN Wei(The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院,陕西西安710061

出　　处：《中国病原生物学杂志》2023年第9期1079-1082,1087,共5页Journal of Pathogen Biology

基　　金：陕西省科技计划项目(No.2022SF-248)。

摘　　要：目的 了解鲍曼不动杆菌临床感染现状和耐药变化趋势,为临床防治提供依据。方法 收集本院2020-2022年分离的鲍曼不动杆菌及相关资料。采用全自动微生物鉴定仪对菌株进行鉴定和药敏试验,采用K-B纸片扩散法和E-test法进行补充试验。采用REP-PCR分析鲍曼不动杆菌同源性。结果 共收集到1 338株鲍曼不动杆菌,其中2020年415株,2021年487株,2022年436株。各科室中ICU检出374株,检出数量最多。其次是呼吸科检出217株。标本以痰液标本为主,占71.17%。鲍曼不动杆菌对头孢噻肟、头孢吡肟、头孢他啶、四环素、多西环素、环丙沙星、加替沙星、哌拉西林、庆大霉素、妥布霉素、阿米卡星、复方新诺明、美洛培南和替加环素耐药率分别为81.02%、76.23%、77.65%、76.01%、67.71%、67.26%、53.51%、80.72%、67.19%、60.99%、45.96%、58.59%、75.78%和1.12%,对多粘菌素B和粘菌素未产生耐药性。其中近3年比较,鲍曼不动杆菌对头孢噻肟、头孢吡肟、头孢他啶和美洛培南耐药率略有上升,对四环素、多西环素、庆大霉素、妥布霉素和阿米卡星耐药率略有下降。碳青霉烯耐药株与敏感株进行对比显示碳青霉烯耐药株对除加替环素、多粘菌素B和粘菌素外的其他抗生素耐药率均高于碳青霉烯敏感株,差异有统计学意义(均P<0.05)。1 338株鲍曼不动杆菌分成15个主基因型,其中A分型2020年至2022年逐年减少,B分型则2021年检出最多,C分型则3年间呈上升趋势。结论 鲍曼不动杆菌在ICU检出最多,标本以痰液为主。它对多种抗生素产生了耐药性,加替环素、多粘菌素B和粘菌素可在治疗鲍曼不动杆菌重度感染时使用。2020-2022年分离的鲍曼不动杆菌的耐药性与基因型发生了一定变化,定期检测耐药变化对临床用药有重要意义。ObjectiveTThe current status of clinical infection and drug resistance trends of Acinetobacter baumannii were analyzed to provide a basis for clinical prevention and treatment.Methods The A.baumanni isolated from our hospital from 2020 to 2022 and related data were collected.The strains were identified and drug sensitivity tests were conducted by a fully automated microbial identification instrument,and supplementary tests were conducted by K-B paper diffusion method and E-test method.The homology of A.baumannii were analyzed by REP-PCR.ResultsA total of 1338 strains of A.baumannii were collected,including 415 in 2020,487 in 2021,and 436 in 2022.In each department,374 strains were detected in the ICU,with the highest number detected.Secondly,217 strains were detected in the respiratory department.The main specimens were sputum specimens,accounting for 71.17%.The resistance rates of A.baumannii to cefotaxime,cefepime,ceftazidime,tetracycline,doxycycline,ciprofloxacin,gatifloxacin,piperacillin,gentamicin,tobramycin,amikacin,compound sulfamethoxazole,meropenem and tigecycline were 81.02%,76.23%,77.65%,76.01%,67.71%,67.26%,53.51%,80.72%,67.19%,60.99%,45.96%,58.59%,75.78%and 1.12%,respectively,There was no resistance to polymyxin B and myxin.In recent three years,the resistance rate of A.baumannii to cefotaxime,cefepime,ceftazidime and meropenem increased slightly,and the resistance rate to tetracycline,doxycycline,gentamicin,tobramycin and amikacin decreased slightly.The comparison between carbapenem resistant strains and sensitive strains showed that carbapenem resistant strains had higher resistance rates to antibiotics except for gaticycline,polymyxin B,and myxin than carbapenem sensitive strains,and the data differences were statistically significant.1338 strains of A.baumannii were divided into 15 main genotypes,with A genotype decreasing year by year from 2020 to 2022,B genotype being the most detected in 2021,and C genotype showing an upward trend over the past three years.ConclusionA.baumannii was most detect

关 键 词：鲍曼不动杆菌 临床分布 耐药性变迁 

分 类 号：R378[医药卫生—病原生物学]