2016—2021年河北省血标本分离鲍曼不动杆菌的耐药性变迁

Change in antimicrobial resistance of Acinetobacter baumannii isolated from blood specimens in Hebei Province from 2016 to 2021

摘要:

目的 分析河北省细菌耐药监测网75所医院2016—2021年血标本分离鲍曼不动杆菌的临床特征及耐药状况。 方法 应用WHONET 5.6和SPSS 24.0软件对2016年1月—2021年12月河北省血标本分离鲍曼不动杆菌的临床分布特征及耐药性变迁进行回顾性分析。 结果 2016—2021年河北省血标本共检出1 739株鲍曼不动杆菌。患者中位年龄为64岁, 男女比例为1.7 ∶1。重症医学科鲍曼不动杆菌检出数量位居第一(769株, 占44.2%), 其对头孢菌素、β-内酰胺酶抑制剂复方制剂、碳青霉烯类抗生素的耐药率均超过75%;门急诊分离株对上述抗生素的耐药率均超过65%, 耐药率仅次于重症医学科, 位居第二。耐碳青霉烯类鲍曼不动杆菌(CRAB)的检出率由2016年的55.9%上升至2019年的69.6%, 在随后的两年中下降了9.0%, 截至2021年检出率为60.6%, 6年间CRAB检出率累积增加了4.7%。除米诺环素、多粘菌素B以外, 不同年龄组患者对其他常见抗菌药物的耐药率比较, 差异均有统计学意义(均P＜0.001);成人患者(≥15岁)血培养分离鲍曼不动杆菌对常见抗菌药物的耐药率普遍高于新生儿及儿童患者(≤14岁)。 结论 2016—2021年河北省血标本分离鲍曼不动杆菌对常见抗菌药物的耐药率较高, 重症医学科与急诊科耐药情况尤为严重。CRAB检出率呈上升趋势, 应继续加强抗菌药物合理使用及医院感染预防与控制。

Abstract:

Objective To analyze the clinical characteristics and antimicrobial resistance of Acinetobacter bauma-nnii (A. baumannii) isolated from blood specimens of 75 hospitals in Hebei Provincial Bacterial Resistance Surveillance System from 2016 to 2021. Methods Clinical distribution and change in antimicrobial resistance of A. baumannii isolated from blood specimens in Hebei Province from January 2016 to December 2021 were retrospectively analyzed by WHONET 5.6 and SPSS 24.0 software. Results From 2016 to 2021, 1 739 strains of A. baumannii were isolated from blood specimens in Hebei Province. The median age of patients was 64 years old, the ratio of male to female was 1.7 ∶1. The number of A. baumannii isolated from department of critical care medicine ranked first (769 strains, 44.2%), resistance rates to cephalosporin, compound preparations of β-lactamase inhibitors and carbapenes exceeded 75%; resistance rates of the strains isolated from outpatient and emergency departments to the above antibiotics agents exceeded 65%, ranking second only to the department of critical care medicine. Isolation rate of carbapenem-resistant A. baumannii (CRAB) increased from 55.9% in 2016 to 69.6% in 2019, and decreased by 9.0% in the following two years, isolation rate was 60.6% by 2021, and the cumulative isolation rate of CRAB increased by 4.7% in 6 years. Except for minocycline and polymyxin B, resistance rates of patients in different age groups to other common antimicrobial agents were significantly different (all P < 0.001); resistance rates of A. baumannii isolated from blood cultures of adult patients (≥15 years old) to common antimicrobial agents is generally higher than that of neonates and children (≤14 years old). Conclusion From 2016 to 2021, resistance rates of A. baumannii isolated from blood specimens in Hebei Province to common antimicrobial agents were high, especially in the department of critical care medicine and emergency department. Isolation rate of CRAB is on the rise, rational use of antimicrobial agents as well as prevention and control of healthcare-associated infection should continue to be strengthened.