重症医学科连续5年鲍曼不动杆菌感染分布及耐药性变迁

Changes in distribution and antimicrobial resistance of Acinetobacter baumannii in 5 consecutive years in an intensive care unit

摘要:

目的了解重症医学科（ICU）鲍曼不动杆菌(AB)感染分布及耐药性变化，为临床合理使用抗菌药物提供参考依据。方法采用回顾性调查方法，收集某院2010—2014年分离自ICU住院患者的病原菌资料，统计分析其构成与耐药性。结果2010—2014年综合ICU共分离病原菌3 807株，其中AB 488株，AB总检出率为12.82%，检出率由2010年的6.94%逐年增加至2014年的17.33%，差异有统计学意义（χ2=45.58，P＜0.01）。检出AB以痰标本为主，占72.13%，其次是伤口分泌物、血、导管及尿等。AB对阿米卡星的耐药率最低（＜30%），对亚胺培南和美罗培南的耐药率逐年上升明显（趋势χ2值分别为42.99、53.91，均P＜0.001)；AB对其他常用抗菌药物的耐药率均＞50%。结论ICU AB检出率及耐药率逐年增加，临床上应加强细菌的耐药性监测工作，积极采取有效措施隔离患者，预防和控制AB在ICU内的聚集流行。

Abstract:

ObjectiveTo investigate the change in distribution and antimicrobial resistance of Acinetobacter baumannii(AB) in an intensive care unit(ICU), and provide basis for rational use of antimicrobial agents in the clinical practice.MethodsUsing retrospective investigation study, data about pathogenic bacteria isolated from patients who were hospitalized in ICU in 2010-2014 were collected, distribution and antimicrobial resistance of AB were statistically analyzed.ResultsA total of 3 807 bacterial strains were isolated from ICU patients in 2010-2014, 488(12.82%) of which were AB, isolation rate increased from 6.94% in 2010 to 17.33% in 2014 （χ2=45.58，P＜0.01）. AB was mainly isolated from sputum, accounting for 72.13%, followed by wound secretion, blood, catheter, urine and so on; AB had the lowest resistance rate to amikacin(<30%), resistance rates to imipenem and meropenem increased significantly year by year (value of trend χ2 test were 42.99 and 53.91 respectively, both P＜0.001);  resistance rates of AB to other antimicrobial agents were all>50%.ConclusionDetection rate and antimicrobial resistance rate of AB increased year by year, clinical surveillance on bacterial resistance should be paid more attention, patients should be isolated by effective measures, so as to control and prevent the prevalence of AB in ICU.