鲍曼不动杆菌临床耐药、分布情况及感染影响因素研究
|
摘要
目的探讨本院分离的鲍曼不动杆菌的临床耐药情况及分布,并分析感染影响因素。方法采用纸片扩散实验法对获得的鲍曼不动杆菌予以药敏测验,并应用WHONET 5.6以及SPSS 20.0软件对鲍曼不动杆菌的分布、药敏情况予以分析,同时对鲍曼不动杆菌的感染影响因素予以单因素统计分析。结果本院2016年1月～2017年12月年培养出非重复性鲍曼不动杆菌共910株,呼吸道标本占71.21%,伤口、引流液及脓液、血液、尿液、脑脊液分别占9.45%、9.23%、2.31%、1.76%。本院鲍曼不动杆菌的科室分布,主要包括康复科、重症监护室、神经外科及神经内科。经药敏结果提示,鲍曼不动杆菌对替加环素、阿米卡星、左氧氟沙星、头孢哌酮/舒巴坦以及氨苄西林/舒巴坦的耐药率较低,其余临床常用的抗菌类药物对于鲍曼不动杆菌的耐药率均较高,其中美罗培南高达89.89%。感染影响因素主要包括格拉斯哥昏迷评分(GCS)≤8分、侵袭性操作、广谱抗菌药物以及患者住院时间≥14 d,差异有统计学意义(χ~2=7.469、7.469、9.593、7.836,P<0.05);而性别、年龄及激素治疗三项因素差异无统计学意义(P>0.05)。结论鲍曼不动杆菌具有较高耐药性,其感染主要影响因素为昏迷、侵袭性操作、广谱抗菌药物及住院时间较长,临床应针对各项因素予以有效的针对性预防。
Objective To investigate the clinical drug resistance and distribution of Acinetobacter baumannii isolated in our hospital, and analyze the influencing factors of infection. Methods The drug sensitivity of Acinetobacter baumannii was tested by disk diffusion test, and the distribution and drug sensitivity of Acinetobacter baumannii were analyzed by who net WHONET 5.6 and SPSS 20.0 software. at the same time, the influencing factors of Acinetobacter baumannii infection were analyzed by single factor statistics. Results A total of 910 strains of non-repetitive acinetobacter baumannii were cultured in our hospital from January 2016 to December 2017, respiratory specimens accounted for71.21%, and wound, drainage and pus, blood, urine and cerebrospinal fluid accounted for 9.45%, 9.23%, 2.31% and1.76% respectively. Department distribution of acinetobacter baumannii in our hospital mainly includes rehabilitation department, intensive care unit, neurosurgery department and neurology department.According to the results of drug sensitivity, the resistance rates of acinetobacter baumannii to tigacycline,amikacin,levofloxacin,cefoperazone/shubatan and ampicillin/shubatan were lower, and the resistance rates of other commonly used antibacterial drugs to acinetobacter baumannii were higher, among which the drug resistance rates of meropenem were up to 89.89%.The main influencing factors of infection include Glasgow coma score(GCS) less than or equal to 8 points, invasive operation, broad-spectrum antibacterial drugs and hospitalization time of patients greater than 14 d, with statistically significant difference(χ~2=7.469, 7.469, 9.593, 7.836, P<0.05). There was no significant difference in sex, age and hormone therapy(P>0.05).Conclusion Acinetobacter baumannii has high drug resistance, and the main influencing factors of its infection are coma,aggressive operation, broad-spectrum antibacterial drugs and long hospitalization time, so it should be effectively targeted and prevented in clinic according to various factors.
Objective To investigate the clinical drug resistance and distribution of Acinetobacter baumannii isolated in our hospital, and analyze the influencing factors of infection. Methods The drug sensitivity of Acinetobacter baumannii was tested by disk diffusion test, and the distribution and drug sensitivity of Acinetobacter baumannii were analyzed by who net WHONET 5.6 and SPSS 20.0 software. at the same time, the influencing factors of Acinetobacter baumannii infection were analyzed by single factor statistics. Results A total of 910 strains of non-repetitive acinetobacter baumannii were cultured in our hospital from January 2016 to December 2017, respiratory specimens accounted for71.21%, and wound, drainage and pus, blood, urine and cerebrospinal fluid accounted for 9.45%, 9.23%, 2.31% and1.76% respectively. Department distribution of acinetobacter baumannii in our hospital mainly includes rehabilitation department, intensive care unit, neurosurgery department and neurology department.According to the results of drug sensitivity, the resistance rates of acinetobacter baumannii to tigacycline,amikacin,levofloxacin,cefoperazone/shubatan and ampicillin/shubatan were lower, and the resistance rates of other commonly used antibacterial drugs to acinetobacter baumannii were higher, among which the drug resistance rates of meropenem were up to 89.89%.The main influencing factors of infection include Glasgow coma score(GCS) less than or equal to 8 points, invasive operation, broad-spectrum antibacterial drugs and hospitalization time of patients greater than 14 d, with statistically significant difference(χ~2=7.469, 7.469, 9.593, 7.836, P<0.05). There was no significant difference in sex, age and hormone therapy(P>0.05).Conclusion Acinetobacter baumannii has high drug resistance, and the main influencing factors of its infection are coma,aggressive operation, broad-spectrum antibacterial drugs and long hospitalization time, so it should be effectively targeted and prevented in clinic according to various factors.
引文
[1]任金芳,陈静.某医院重症监护室多重耐药鲍曼不动杆菌感染的危险因素及防控[J].解放军预防医学杂志,2015,33(3):285-286.
[2]杨健,江培涛,杨正南,等.2008-2012年鲍曼不动杆菌感染分布特征及耐药性变迁[J].检验医学与临床,2013,10(21):2874-2875.
[3]罗云桃,乔昀.某院鲍曼不动杆菌感染的分布及耐药性分析[J].国际检验医学杂志,2014,35(16):2197-2199.
[4]临床实验室标准化协会,2014CLSI M100-S24.抗微生物药物敏感性试验的执行标准第二十四版信息增刊[S].2014.
[5]周娇娇,朱惠莉.鲍曼不动杆菌对碳青霉烯类抗生素的耐药机制[J].中国感染与化疗杂志,2014,14(5):446-450.
[6]肖淑珍,徐桂婷,方洁,等.鲍曼不动杆菌耐药性与抗菌药物使用情况的相关性分析[J].中国感染与化疗杂志,2013,13(6):446-449.
[7]周燕飞,邓敏.连续3年临床分离鲍曼不动杆菌临床分布及耐药性[J].中国感染控制杂志,2015,1(14):42-44.
[8]孙成栋,李真,刘斯,等.泛耐药鲍曼不动杆菌医院感染的耐药性分析[J].中华危重病急救医学,2013,25(6):369-372.
[9]刘红巧,陈娜,苏建荣.鲍曼不动杆菌感染情况及耐药性分析[J].临床和实验医学杂志,2016,15(2):190-192.
[10]马全萍,张倩,孙玉国,等.鲍曼不动杆菌的临床分布及耐药变化趋势[J].现代预防医学,2015,42(23):4412-4413.
[11]周华,周建英,俞云松.中国鲍曼不动杆菌感染诊治与防控专家共识解读[J].中国循证医学杂志,2016,16(1):26-29.
[12]何振辉,严俭敏,钟瑞雪,等.鲍曼不动杆菌的临床分布、耐药表型分析及防治对策[J].中华疾病控制杂志,2014,18(7):674-677.
[13]吕晓菊,曲俊彦.多重耐药鲍曼不动杆菌感染治疗策略与展望[J].西部医学,2016,28(1):3-7,14.
[14]陈代杰,郭蓓宁,杨信怡,等.鲍曼不动杆菌耐药机制[J]中国感染与化疗杂志,2015,15(3):286-288.
[15]蒋陆霞,贾秀芹,庞峰,等.2009-2014年我院抗菌药物临床应用对鲍曼不动杆菌耐药性变迁的影响[J].国际医药卫生导报,2016,22(10):1343-1346.
[16]尧荣凤,沈菊英,许国祥,等.综合医院鲍曼不动杆菌的临床分布及耐药分析[J].国际检验医学杂志,2017,38(2):194-197.
[17]熊莺,孙午.多重耐药鲍曼不动杆菌药敏情况分析[J]中国现代医生,2017,55(36):128-130.
[18]涂盛,邵安文,朱曼华,等.鲍曼不动杆菌的临床分布、耐药情况及其感染危险因素分析[J].中国微生态学杂志,2016,28(12):1416-1418,1428.
[19]陆一丹,张亚莉,周浩,等.泛耐药鲍曼不动杆菌的体外联合药敏分析[J].南方医科大学学报,2014,34(11):1697-1701.
[20]曹诗悦,张静萍,张岩岩,等.2013-2014年50株鲍曼不动杆菌耐药性分析及联合药敏实验研究[J].临床军医杂志,2017,45(5):485-492.
[21]邹敏,郭普,李峰,等.638株鲍曼不动杆菌的临床分布及耐药性分析[J].中国医学创新,2017,14(35):85-88.
[22]李仁杰,赵建江,王胜.514株鲍曼不动杆菌的临床分布和耐药性分析[J].当代医学,2018,22(13):129-130.
[23]王珀.228株鲍曼不动杆菌感染的临床分布和耐药性分析[J].中国当代医药,2018,11(27):129-131.
[2]杨健,江培涛,杨正南,等.2008-2012年鲍曼不动杆菌感染分布特征及耐药性变迁[J].检验医学与临床,2013,10(21):2874-2875.
[3]罗云桃,乔昀.某院鲍曼不动杆菌感染的分布及耐药性分析[J].国际检验医学杂志,2014,35(16):2197-2199.
[4]临床实验室标准化协会,2014CLSI M100-S24.抗微生物药物敏感性试验的执行标准第二十四版信息增刊[S].2014.
[5]周娇娇,朱惠莉.鲍曼不动杆菌对碳青霉烯类抗生素的耐药机制[J].中国感染与化疗杂志,2014,14(5):446-450.
[6]肖淑珍,徐桂婷,方洁,等.鲍曼不动杆菌耐药性与抗菌药物使用情况的相关性分析[J].中国感染与化疗杂志,2013,13(6):446-449.
[7]周燕飞,邓敏.连续3年临床分离鲍曼不动杆菌临床分布及耐药性[J].中国感染控制杂志,2015,1(14):42-44.
[8]孙成栋,李真,刘斯,等.泛耐药鲍曼不动杆菌医院感染的耐药性分析[J].中华危重病急救医学,2013,25(6):369-372.
[9]刘红巧,陈娜,苏建荣.鲍曼不动杆菌感染情况及耐药性分析[J].临床和实验医学杂志,2016,15(2):190-192.
[10]马全萍,张倩,孙玉国,等.鲍曼不动杆菌的临床分布及耐药变化趋势[J].现代预防医学,2015,42(23):4412-4413.
[11]周华,周建英,俞云松.中国鲍曼不动杆菌感染诊治与防控专家共识解读[J].中国循证医学杂志,2016,16(1):26-29.
[12]何振辉,严俭敏,钟瑞雪,等.鲍曼不动杆菌的临床分布、耐药表型分析及防治对策[J].中华疾病控制杂志,2014,18(7):674-677.
[13]吕晓菊,曲俊彦.多重耐药鲍曼不动杆菌感染治疗策略与展望[J].西部医学,2016,28(1):3-7,14.
[14]陈代杰,郭蓓宁,杨信怡,等.鲍曼不动杆菌耐药机制[J]中国感染与化疗杂志,2015,15(3):286-288.
[15]蒋陆霞,贾秀芹,庞峰,等.2009-2014年我院抗菌药物临床应用对鲍曼不动杆菌耐药性变迁的影响[J].国际医药卫生导报,2016,22(10):1343-1346.
[16]尧荣凤,沈菊英,许国祥,等.综合医院鲍曼不动杆菌的临床分布及耐药分析[J].国际检验医学杂志,2017,38(2):194-197.
[17]熊莺,孙午.多重耐药鲍曼不动杆菌药敏情况分析[J]中国现代医生,2017,55(36):128-130.
[18]涂盛,邵安文,朱曼华,等.鲍曼不动杆菌的临床分布、耐药情况及其感染危险因素分析[J].中国微生态学杂志,2016,28(12):1416-1418,1428.
[19]陆一丹,张亚莉,周浩,等.泛耐药鲍曼不动杆菌的体外联合药敏分析[J].南方医科大学学报,2014,34(11):1697-1701.
[20]曹诗悦,张静萍,张岩岩,等.2013-2014年50株鲍曼不动杆菌耐药性分析及联合药敏实验研究[J].临床军医杂志,2017,45(5):485-492.
[21]邹敏,郭普,李峰,等.638株鲍曼不动杆菌的临床分布及耐药性分析[J].中国医学创新,2017,14(35):85-88.
[22]李仁杰,赵建江,王胜.514株鲍曼不动杆菌的临床分布和耐药性分析[J].当代医学,2018,22(13):129-130.
[23]王珀.228株鲍曼不动杆菌感染的临床分布和耐药性分析[J].中国当代医药,2018,11(27):129-131.