痰标本中耐亚胺培南鲍曼不动杆菌检出变化趋势及耐药性

Change in detection trend and antimicrobial resistance of imipenemresistant Acinetobacter baumannii from sputum specimens

摘要:

目的了解痰中耐亚胺培南鲍曼不动杆菌(IRAB)检出情况、耐药性及病区分布。方法 回顾性分析2009年1月1日—2013年9月30日某院痰标本分离的鲍曼不动杆菌(AB)，比较IRAB和非IRAB的病区分布、耐药性，以及IRAB检出率的变化趋势。结果痰中共检出AB 711株，其中IRAB 442株，非IRAB 269株。AB主要分布在重症监护病房（ICU，39.10%）和神经内科（25.18%）；ICU检出IRAB 254株（占57.47%），多于非IRAB（24株，占8.92%），差异有统计学意义(χ2=165.50，P＜0.05)；IRAB的检出率：ICU（91.37%）高于非ICU（43.42%），差异有统计学意义(χ2=257.29，P＜0.05)。2009—2013年IRAB的检出率持续升高（分别为25.30%、36.36%、74.68%、65.56%和90.07%）。IRAB对阿米卡星的耐药率较低（27.25%），非IRAB对阿米卡星和哌拉西林/他唑巴坦的耐药率较低（7.31%、8.24%）；除复方磺胺甲口恶唑外，IRAB对其他抗菌药物的耐药率均高于非IRAB，差异均有统计学意义(均P＜0.05)。结论痰中IRAB检出率和耐药率均较高，临床应做到早培养、早治疗、早隔离，减少医院多重耐药菌的产生。

Abstract:

ObjectiveTo  realize detection, antimicrobial resistance, and ward distribution of imipenemresistant Acinetobacter baumannii (IRAB ) from sputum.MethodsAB strains isolated from sputum specimens in a hospital between January 1, 2009 and  September 30, 2013 were analyzed retrospectively.  Ward distribution, antimicrobial resistance, and isolation rates  between  IRAB and nonIRAB strains were compared.Results711 AB strains were isolated from sputum, 442 of which were IRAB, 269 were nonIRAB.AB were mainly distributed in intensive care unit(ICU, 39.10%) and neurology department (25.18%) ; detection rate of IRAB was  significantly higher than nonIRAB in ICU (57.47%［n=254］ vs  8.92%［n=24］,χ2=165.50,P＜0.05)， detection rate of IRAB in ICU was significantly higher than nonICU (91.37% vs 43.42%, χ2=257.29,P＜0.05). Detection rates of IRAB in 2009-2013 increased continuously (25.30%， 36.36%， 74.68%， 65.56%, and 90.07%, respectively). The resistant rate of IRAB to amikacin was low (27.25%)， resistant rates of nonIRAB to amikacin and piperacillin /tazobactam were both low (7.31% and 8.24% respectively);except compound sulfamethoxazole， resistant rates of IRAB to other antimicrobial agents were all significantly higher than nonIRAB strains (all P＜0.05).ConclusionThe detection rate and drug resistant rate of IRAB from sputum are both high,  early culture， early treatment，and early isolation should be carried out to reduce the emergence of multidrugresistant organisms.