2015-2017年昆明市第三人民医院多重耐药鲍曼不动杆菌临床分布及耐药情况
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摘要
目的:监测昆明市第三人民医院多重耐药鲍曼不动杆菌(MDR-AB)临床分布及耐药性变化,为指导临床合理使用抗菌药、控制鲍曼不动杆菌感染提供依据。方法:回顾性收集2015-2017年本院临床分离的非重复MDR-AB菌株,分析MDR-AB菌株数、科室分布、标本来源及对17种抗菌药的耐药性变化。结果:2015-2017年本院共检出非重复MDR-AB140株。MDR-AB占鲍曼不动杆菌比例和占年度病原菌总数比例均呈逐年上升趋势。科室分布主要为ICU(60.0%),其次为结核二科(10.0%)、呼吸科(7.9%)。ICU科室分布构成比逐年下降,而结核二科、呼吸科则均呈逐年增加趋势。标本来源构成比主要是痰液(70.7%)和支气管刷物(21.4%)。2015-2017年MDR-AB对阿米卡星耐药率最低,总耐药率为50.0%,对氨苄西林、阿莫西林/克拉维酸钾、头孢唑林钠总耐药率≥93.6%。MDR-AB对阿米卡星、头孢唑林钠、亚胺培南/西司他汀钠、哌拉西林钠、四环素5种抗菌药耐药率呈逐年上升趋势,但总体差异无统计学意义(P>0.05);对其余12种抗菌药耐药率亦呈逐年上升趋势,且总体差异具有统计学意义(P<0.05)。结论:2015-2017年本院MDR-AB分离率和耐药率均呈逐年增加趋势。医院应制定更有效的感染控制措施,加强MDR-AB的动态监测及消毒隔离工作,合理使用广谱抗菌药,预防和减少院内MDR-AB的产生和传播。
Objective:To monitor clinical distribution and drug resistance of the multidrug-resistant Acinetobacter baumannii(MDR-AB)in the Third People's Hospital of Kunming City,so as to provide evidence for rational use of antibacterials and control of infection by A.baumannii.Methods:MDR-AB strains were collected retrospectively from 2015 to 2017 in our hospital.The strain numbers,department distribution,specimen sources and drug resistance changes of MDR-AB to 17 kinds of antibacterials were analyzed.Results:Totally,140 MDR-AB strains were detected in our hospital from 2015 to 2017.The proportions of MDR-AB to A.baumannii and to total pathogens per year displayed an increasing trend.MDR-AB mainly distributed in ICU(60.0%),followed by the Second Department of Tuberculosis(10.0%)and Department of Respiratory Medicine(7.9%).The distribution of MDR-AB in ICU decreased year by year,while the distribution of MDR-AB in the Second Department of Tuberculosis and Department of Respiratory Medicine increased year by year.The main sources of MDR-AB specimens were sputum(70.7%)and bronchial brushing(21.4%).The resistance rate of MDR-AB to amikacin was the lowest from 2015 to2017,and the overall resistance rate was 50.0%.The overall resistance rates of MDR-AB to ampicillin,amoxillin/clavulanate potassium and cefazolin sodium were above 93.6%.The resistance rates of MDR-AB to amikacin,cefazolin sodium,imipenem/simvastatin sodium,piperacillin sodium and tetracycline increased year by year,but on the whole,no statistical significance could be seen(P>0.05).The resistance of MDR-AB to the other 12 antibacterials also increased year by year,and with statistical significance(P<0.05).Conclusion:The separation rate and drug resistance rate of MDR-AB increased year by year from2015 to 2017 in our hospital.More effective infection control measures should be taken by the hospital,dynamic monitoring of MDR-AB,disinfection and isolation should be strengthened,and broad-spectrum antibacterials should be used rationally,so as to prevent and reduce the growth and transmission of MDR-AB in the hospital.
Objective:To monitor clinical distribution and drug resistance of the multidrug-resistant Acinetobacter baumannii(MDR-AB)in the Third People's Hospital of Kunming City,so as to provide evidence for rational use of antibacterials and control of infection by A.baumannii.Methods:MDR-AB strains were collected retrospectively from 2015 to 2017 in our hospital.The strain numbers,department distribution,specimen sources and drug resistance changes of MDR-AB to 17 kinds of antibacterials were analyzed.Results:Totally,140 MDR-AB strains were detected in our hospital from 2015 to 2017.The proportions of MDR-AB to A.baumannii and to total pathogens per year displayed an increasing trend.MDR-AB mainly distributed in ICU(60.0%),followed by the Second Department of Tuberculosis(10.0%)and Department of Respiratory Medicine(7.9%).The distribution of MDR-AB in ICU decreased year by year,while the distribution of MDR-AB in the Second Department of Tuberculosis and Department of Respiratory Medicine increased year by year.The main sources of MDR-AB specimens were sputum(70.7%)and bronchial brushing(21.4%).The resistance rate of MDR-AB to amikacin was the lowest from 2015 to2017,and the overall resistance rate was 50.0%.The overall resistance rates of MDR-AB to ampicillin,amoxillin/clavulanate potassium and cefazolin sodium were above 93.6%.The resistance rates of MDR-AB to amikacin,cefazolin sodium,imipenem/simvastatin sodium,piperacillin sodium and tetracycline increased year by year,but on the whole,no statistical significance could be seen(P>0.05).The resistance of MDR-AB to the other 12 antibacterials also increased year by year,and with statistical significance(P<0.05).Conclusion:The separation rate and drug resistance rate of MDR-AB increased year by year from2015 to 2017 in our hospital.More effective infection control measures should be taken by the hospital,dynamic monitoring of MDR-AB,disinfection and isolation should be strengthened,and broad-spectrum antibacterials should be used rationally,so as to prevent and reduce the growth and transmission of MDR-AB in the hospital.
引文
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[6]宋晓萍,陈佳红,翟军清,等.青岛地区重症监护病房分离的鲍曼不动杆菌耐药特征及碳青霉烯酶基因型的研究[J].中华检验医学杂志,2017,40(3):216-220.SONG XiaoPing,CHEN JiaHong,ZHAI JunQing,et al.A study of antibiotics resistance and carbapenemase genotype of Acinetobacter baumannii in intensive care unit of Qingdao[J].Chin J Lab Med,2017,40(3):216-220.In Chinese with English abstract.
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[8]何乐,肖淑珍,韩立中,等.鲍曼不动杆菌的耐药性与抗菌药物使用强度的相关性分析[J].药学服务与研究,2014,14(5):360-363.HE Le,XIAO ShuZhen,HAN LiZhong,et al.The correlation between drug resistance of Acinetobacter baumannii and antibacterial use density[J].Pharm Care Res,2014,14(5):360-363.In Chinese with English abstract.
[9]梁佩佩,卢洪洲.多重耐药菌的医院感染防控及管理模式[J].临床内科杂志,2018,35(3):158-160.LIANG PeiPei,LU HongZhou.Prevention,control and management patterns of hospital infections caused by multi-drug resistant bacteria[J].J Clin Intern Med,2018,35(3):158-160.In Chinese.
[2]张辉,张小江,徐英春,等.2005-2014年CHINET不动杆菌属细菌耐药性监测[J].中国感染与化疗杂志,2016,16(4):429-436.ZHANG Hui,ZHANG XiaoJiang,XU YingChun,et al.Resistance profile of Acinetobacter isolates in hospitals across China:results from CHINET Antimicrobial Resistance Surveillance Program 2005-2014[J].Chin J Infect Chemother,2016,16(4):429-436.In Chinese with English abstract.
[3]陈佰义,何礼贤,胡必杰,等.中国鲍曼不动杆菌感染诊治与防控专家共识[J].中华医学杂志,2012,92(2):76-85.CHEN BaiYi,HE LiXian,HU BiJie,et al.Expert consensus on the prevention,diagnosis and treatment of infection by Acinetobacter baumannii in China[J].Natl Med J China,2012,92(2):76-85.In Chinese.
[4]张宇琼,高晶晶,陆文香,等.我院2014-2017年鲍曼不动杆菌的临床分布、耐药性及耐药基因研究[J].中国药房,2018,29(6):794-799.ZHANG YuQiong,GAO JingJing,LU WenXiang,et al.Clinical distribution,drug resistance and drug resistance genes of Acinetobacter baumannii in our hospital from 2014to 2017[J].China Pharmacy,2018,29(6):794-799.In Chinese with English abstract.
[5]孟芝君.碳青霉烯类耐药鲍曼不动杆菌1060株临床分布与耐药性分析[J].中国药物与临床,2017,17(11):1609-1611.MENG ZhiJun.Clinical distribution and drug resistance analysis of 1060strains of carbapenem-resistant Acinetobacter baumannii[J].Chin Remed Clin,2017,17(11):1609-1611.In Chinese.
[6]宋晓萍,陈佳红,翟军清,等.青岛地区重症监护病房分离的鲍曼不动杆菌耐药特征及碳青霉烯酶基因型的研究[J].中华检验医学杂志,2017,40(3):216-220.SONG XiaoPing,CHEN JiaHong,ZHAI JunQing,et al.A study of antibiotics resistance and carbapenemase genotype of Acinetobacter baumannii in intensive care unit of Qingdao[J].Chin J Lab Med,2017,40(3):216-220.In Chinese with English abstract.
[7]孙世鹏,旷南岳,漆新文.多重耐药鲍曼不动杆菌感染相关危险因素及耐药性分析[J].临床合理用药,2018,11(1A):7-11.SUN ShiPeng,KUANG NanYue,QI XinWen.Multiple drug resistant Acinetobacter baumannii infection associated risk factors and drug resistance analysis[J].Chin J Clin Ration Drug Use,2018,11(1A):7-11.In Chinese with English abstract.
[8]何乐,肖淑珍,韩立中,等.鲍曼不动杆菌的耐药性与抗菌药物使用强度的相关性分析[J].药学服务与研究,2014,14(5):360-363.HE Le,XIAO ShuZhen,HAN LiZhong,et al.The correlation between drug resistance of Acinetobacter baumannii and antibacterial use density[J].Pharm Care Res,2014,14(5):360-363.In Chinese with English abstract.
[9]梁佩佩,卢洪洲.多重耐药菌的医院感染防控及管理模式[J].临床内科杂志,2018,35(3):158-160.LIANG PeiPei,LU HongZhou.Prevention,control and management patterns of hospital infections caused by multi-drug resistant bacteria[J].J Clin Intern Med,2018,35(3):158-160.In Chinese.