2012～2014年耐碳青霉烯类鲍曼不动杆菌临床分布特征和耐药性分析
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摘要
目的了解耐碳青霉烯类鲍曼不动杆菌(CRAB)的临床分布特征及其耐药性,为指导临床合理用药、明确有效控制医院感染提供依据。方法收集2012~2014年临床分离的CRAB标本,分析其临床分布特征及耐药性,并进行统计学分析。结果 3年共检出179株CRAB,主要来自痰液(84.4%)和创口分泌物(11.7%),检出科室以ICU(45.8%)、呼吸内科(26.3%)多见。氨基苷类抗生素(庆大霉素、妥布霉素、阿米卡星)耐药率为69%~97%,179株CRAB对第三代头孢菌素(头孢他啶、头孢噻肟、头孢曲松)的耐药率为66%~94%,对β-内酰胺酶抑制剂(哌拉西林-他唑巴坦、氨苄西林-舒巴坦)的耐药率为71%~92%,对头孢哌酮-舒巴坦的耐药率为39%~66%,对喹诺酮类抗菌药(环丙沙星、氧氟沙星)的耐药率为64%~95%,对β-内酰胺类抗菌药(哌拉西林、氨曲南)的耐药率为91%~98%,对磺胺类抗生素抗菌药(复方磺胺甲唑)的耐药率为25%~90%,对米诺环素的耐药率为18%~66%,对多粘菌素类(粘菌素、多粘菌素B)的耐药率为7%~32%。3年间CRAB对妥布霉素、阿米卡星、环丙沙星、氧氟沙星、哌拉西林-他唑巴坦、头孢哌酮-舒巴坦、氨苄西林-舒巴坦、头孢噻肟、头孢曲松、米诺环素、庆大霉素、复方磺胺甲唑、粘菌素、多粘菌素B的耐药率逐年上升(P均<0.05)。结论临床医师应提高合理用药意识,避免滥用抗菌药物,同时应加强CRAB耐药性监测,以有效防治CRAB感染。
Objective To investigate the clinical distribution characteristics and drug resistance of carbapenem-resistant Acinetobacter baumannii( CRAB),aiming to provide evidence for reasonable medication use and effective control of nosocomial infection. Methods The clinically isolated CRAB samples were collected. The clinical distribution and drug resistance of CRAB were statistically analyzed. Results A total of179 CRAB were detected in three years,of which 151 strains( 84. 4%) from the sputum and 21( 11. 7%)from the wound secretions. The CRAB was mainly distributed in the intensive care unit( ICU) and Department of Respiratory Medicine. The drug-resistant rates of CRAB for aminoglycoside antibiotics( Gentamicin,Tobramycin and Amikacin) were ranged from 69% to 97%,66%-94% for the 3 rd-generation cephalosporins(Ceftazidime,Cefotaxime and Ceftriaxone),71%-92% for β-lactamase inhibitors(Piperacillin/tamazobatam,Ampicillin/zubatam),39%-66% for cefoperazon/zubatam,64%-95% for quinolones( Ciprofloxacin and Oxyfloxacin),91%-98% for β-lactam( Piperacillin and Aminotronine),25%-90% for sulfa antibiotics( compound sulfamethoxazole),18%-66% for minocycline and 7%-32% for polymyxin( Mucin and Polymyxide B),respectively. From 2012 to 2014,the drug-resistant rate of CRAB to these drugs was significantly increased year by year( all P < 0. 05). Conclusion Clinicians should enhance the awareness of rational drug use,avoid abuse of antibiotics and strengthen the monitoring of drug resistance of CRAB to effectively prevent the CRAB infection.
Objective To investigate the clinical distribution characteristics and drug resistance of carbapenem-resistant Acinetobacter baumannii( CRAB),aiming to provide evidence for reasonable medication use and effective control of nosocomial infection. Methods The clinically isolated CRAB samples were collected. The clinical distribution and drug resistance of CRAB were statistically analyzed. Results A total of179 CRAB were detected in three years,of which 151 strains( 84. 4%) from the sputum and 21( 11. 7%)from the wound secretions. The CRAB was mainly distributed in the intensive care unit( ICU) and Department of Respiratory Medicine. The drug-resistant rates of CRAB for aminoglycoside antibiotics( Gentamicin,Tobramycin and Amikacin) were ranged from 69% to 97%,66%-94% for the 3 rd-generation cephalosporins(Ceftazidime,Cefotaxime and Ceftriaxone),71%-92% for β-lactamase inhibitors(Piperacillin/tamazobatam,Ampicillin/zubatam),39%-66% for cefoperazon/zubatam,64%-95% for quinolones( Ciprofloxacin and Oxyfloxacin),91%-98% for β-lactam( Piperacillin and Aminotronine),25%-90% for sulfa antibiotics( compound sulfamethoxazole),18%-66% for minocycline and 7%-32% for polymyxin( Mucin and Polymyxide B),respectively. From 2012 to 2014,the drug-resistant rate of CRAB to these drugs was significantly increased year by year( all P < 0. 05). Conclusion Clinicians should enhance the awareness of rational drug use,avoid abuse of antibiotics and strengthen the monitoring of drug resistance of CRAB to effectively prevent the CRAB infection.
引文
[1]Giannouli M,Cuccurullo S,Crivaro V,Di Popolo A,Bernardo M,Tomasone F,Amato G,Brisse S,Triassi M,Utili R,Zarrilli R.Molecular epidemiology of multidrug-resistant Acinetobacter baumannii in a tertiary care hospital in Naples,Italy,shows the emergence of a novel epidemic clone.J Clin Microbiol,2010,48(4):1223-1230.
[2]卫生部临床检验中心.全国临床检验操作.3版.南京:东南大学出版社,2006:827-828.
[3]Dizbay M,Tunccan OG,Sezer BE,Hizel K.Nosocomial imipenem-resistant Acinetobacter baumannii infections:epidemiology and risk factors.Scand J Infect Dis,2010,42(10):741-746.
[4]杨均均,黄问祥,史芳静.耐碳青霉烯鲍曼不动杆菌流行特征及耐药基因分析.中国抗生素杂志,2012,32(5):343-347.
[5]魏绪霞,陆平兰,黎利娟,安玉玲,吕海金,易小猛,刘剑戎,熊亮,周密,易慧敏.外科ICU院内感染的病原菌及其耐药性分析.新医学,2014,45(11):718-723.
[6]雷红,黄留玉,董梅.我院耐碳青霉烯类鲍曼不动杆菌的耐药性分析.武警医学,2011,22(11):955-957.
[7]Roca I,Espinal P,Vila-Farrés X,Vila J.The Acinetobacter baumannii oxymoron:commensal hospital dweller turned pan-drug-resistant menace.Front Microbiol,2012,3:148.
[8]黄勋,邓子德,倪语星,邓敏,胡必杰,李六亿,李家斌,周伯平,王选锭,宗志勇,刘正印,任南,李卫光,邹明祥,徐修礼,周建英,侯铁英,鲜于舒铭,胡成平,艾宇航,王玉宝,秦秉玉,刘进,吴佳玉,郑波,孙树梅,赵鸣雁,吴安华.多重耐药菌医院感染预防与控制中国专家共识.中国感染控制杂志,2015,14(1):1-9.
[2]卫生部临床检验中心.全国临床检验操作.3版.南京:东南大学出版社,2006:827-828.
[3]Dizbay M,Tunccan OG,Sezer BE,Hizel K.Nosocomial imipenem-resistant Acinetobacter baumannii infections:epidemiology and risk factors.Scand J Infect Dis,2010,42(10):741-746.
[4]杨均均,黄问祥,史芳静.耐碳青霉烯鲍曼不动杆菌流行特征及耐药基因分析.中国抗生素杂志,2012,32(5):343-347.
[5]魏绪霞,陆平兰,黎利娟,安玉玲,吕海金,易小猛,刘剑戎,熊亮,周密,易慧敏.外科ICU院内感染的病原菌及其耐药性分析.新医学,2014,45(11):718-723.
[6]雷红,黄留玉,董梅.我院耐碳青霉烯类鲍曼不动杆菌的耐药性分析.武警医学,2011,22(11):955-957.
[7]Roca I,Espinal P,Vila-Farrés X,Vila J.The Acinetobacter baumannii oxymoron:commensal hospital dweller turned pan-drug-resistant menace.Front Microbiol,2012,3:148.
[8]黄勋,邓子德,倪语星,邓敏,胡必杰,李六亿,李家斌,周伯平,王选锭,宗志勇,刘正印,任南,李卫光,邹明祥,徐修礼,周建英,侯铁英,鲜于舒铭,胡成平,艾宇航,王玉宝,秦秉玉,刘进,吴佳玉,郑波,孙树梅,赵鸣雁,吴安华.多重耐药菌医院感染预防与控制中国专家共识.中国感染控制杂志,2015,14(1):1-9.