呼吸与危重症医学科鲍曼不动杆菌感染情况及耐药性分析
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摘要
目的分析北京安贞医院呼吸与危重症医学科鲍曼不动杆菌感染情况及耐药性变迁。方法回顾性分析2005年1月-2016年12月北京安贞医院呼吸与危重症医学科住院患者感染的鲍曼不动杆菌感染以及耐药性等情况,分三个阶段(Ⅰ阶段为2005-2008年,Ⅱ阶段为2009-2012年,Ⅲ阶段为2013-2016年)进行分析。结果 2005-2016年共分离出鲍曼不动杆菌1382株,其中Ⅰ、Ⅱ、Ⅲ阶段分别为206、496、680株。鲍曼不动杆菌在标本中的分布以呼吸道分泌物为主,达98. 22%,其次血液为1. 37%,尿液为1. 30%。在药敏结果中,鲍曼不动杆菌对替加环素耐药率最低为1. 35%。在Ⅰ、Ⅱ、Ⅲ阶段,鲍曼不动杆菌对头孢哌酮/舒巴坦的耐药率较低,分别为26. 00%、15. 08%、25. 73%;对亚胺培南的耐药率分别为27. 18%、84. 01%、83. 04%,对美罗培南耐药率分别为51. 52%、83. 49%、77. 62%。在Ⅲ阶段,鲍曼不动杆菌对左氧氟沙星的耐药率为60. 86%,对哌拉西林/他唑巴坦、环丙沙星、头孢他啶及头孢曲松的耐药率均在80%以上。结论鲍曼不动杆菌对多种抗菌药物呈严重耐药,治疗困难。临床需通过加强细菌的耐药性监测,根据药敏试验结果合理选择抗菌药物,并加强院感管理等措施,有效控制耐药菌株的流行及医院感染。
Objective To investigate the infection status and antibiotic-resistance of Acinetobacter baumannii isolated from department of pulmonary and critical care medicine in Beijing Anzhen Hospital. Methods A retrospective analysis of the infection status and antibiotic resistance of Acinetobacter baumannii in patients in the Department of pulmonary and critical care medicine of Beijing Anzhen Hospital from January 2005 to December 2016 were made. The data of Acinetobacter baumannii isolated was divided into three phases( 2005-2008,2009-2012 and2013-2016). Results Among all Acinetobacter baumannii isolates( n = 1382),there were 206 Acinetobacter baumannii isolates at phase Ⅰ,496 at phase Ⅱ,and 680 at phase Ⅲ. Acinetobacter baumannii isolated rate was the highest in the respiratory tract,up to 98. 22%,followed by 1. 37% in blood and 1. 3% in urine. In the results of drug susceptibility,Acinetobacter baumannii had the lowest resistance to acycline( 1. 35%). At phases Ⅰ,Ⅱ andⅢ,the drug resistance of Acinetobacter baumannii to cefoperazone/sulbactam was 26. 00%,15. 08% and 25. 73%,respectively. The drug resistance of Acinetobacter baumannii to imipenem was 27. 18%,84. 01% and 83. 04%,and51. 52%,83. 49% and 77. 62% to meropenem,respectively. At phase Ⅲ,the drug resistance of Acinetobacter baumannii to levofloxacin was 60. 86% and to piperacillin/tazolaban,ciprofloxacin and three generations of cephalosporins like ceftazidime and ceftriaxone was higher than 80%. Conclusion In recent years,due to the irrational use of antimicrobial agents,the drug resistance rate of Acinetobacter baumannii to most drugs is also increasing and is difficult to treat. Antimicrobial resistance monitoring should be strengthened and antimicrobial agents should be selected according to the drug sensitization results,and the epidemic and hospital infection of resistant strains can be effectively controlled by strengthening hospital sense management and other comprehensive measures.
Objective To investigate the infection status and antibiotic-resistance of Acinetobacter baumannii isolated from department of pulmonary and critical care medicine in Beijing Anzhen Hospital. Methods A retrospective analysis of the infection status and antibiotic resistance of Acinetobacter baumannii in patients in the Department of pulmonary and critical care medicine of Beijing Anzhen Hospital from January 2005 to December 2016 were made. The data of Acinetobacter baumannii isolated was divided into three phases( 2005-2008,2009-2012 and2013-2016). Results Among all Acinetobacter baumannii isolates( n = 1382),there were 206 Acinetobacter baumannii isolates at phase Ⅰ,496 at phase Ⅱ,and 680 at phase Ⅲ. Acinetobacter baumannii isolated rate was the highest in the respiratory tract,up to 98. 22%,followed by 1. 37% in blood and 1. 3% in urine. In the results of drug susceptibility,Acinetobacter baumannii had the lowest resistance to acycline( 1. 35%). At phases Ⅰ,Ⅱ andⅢ,the drug resistance of Acinetobacter baumannii to cefoperazone/sulbactam was 26. 00%,15. 08% and 25. 73%,respectively. The drug resistance of Acinetobacter baumannii to imipenem was 27. 18%,84. 01% and 83. 04%,and51. 52%,83. 49% and 77. 62% to meropenem,respectively. At phase Ⅲ,the drug resistance of Acinetobacter baumannii to levofloxacin was 60. 86% and to piperacillin/tazolaban,ciprofloxacin and three generations of cephalosporins like ceftazidime and ceftriaxone was higher than 80%. Conclusion In recent years,due to the irrational use of antimicrobial agents,the drug resistance rate of Acinetobacter baumannii to most drugs is also increasing and is difficult to treat. Antimicrobial resistance monitoring should be strengthened and antimicrobial agents should be selected according to the drug sensitization results,and the epidemic and hospital infection of resistant strains can be effectively controlled by strengthening hospital sense management and other comprehensive measures.
引文
[1]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[S].中华医学杂志,2012,92(2):76-85.
[2] MUNOZ-PRICE L S,ROBERT A W. Acinetobacter Infection[J].N Engl J Med,2008,358(12):1271-1281.
[3] CHITTAWATANARAT K,JAIPAKDEE W,CHOTIROSNIRAMIT N,et al. Microbiology,resistance patterns,and risk factors of mortality in ventilator-associated bacterial pneumonia in a Northern Thai tertiary-care university based general surgical intensive care unit[J]. Infect Drug Resist,2014,7:203-210.
[4] ORSI G B,FRANCHI C,GIORDANO A,et al. Multidrug-resistant Acinetobacter baumannii outbreak in an intensive care unit[J]. J Chemother,2008,20(2):219-224.
[5] PELEG A Y,SEIFERT H,PATERSON D L. Acinetobacter baumannii:Emergence of a suceessful pathogen[J]. Clin Microbiol Rev,2008,21(3):538-582.
[6]高伟,张艳艳,刘双,等.重症监护病房鲍曼不动杆菌的耐药性分析[J].中华结核和呼吸杂志,2006,29(11):782.
[7] SOFIA M,ELPIS M,VIKTORIA E M,et al. A 5-year surveillance study on antimicrobial resistance of acinetobacter baumannii clinical isolates from a tertiary greek hospital[J]. Infect Chemother,2016,48(3):190-198.
[8]刘彦伶,毛静,贾蓓.鲍曼不动杆菌耐药及治疗进展[J].国外医药(抗生素分册),2015,36(2):63-67.
[9] ORSI G B,FRANCHI C,MARRONE R,et al. Laboratory confirmed bloodstream infection aetiology in an intensive care unit:Eight years study[J]. Ann Ig,2012,24(4):269-278.
[10] KIM S Y,JUNG J Y,KANG Y A,et al. Risk factors for occurrence and 30day mortality for carbapenem-resistant Acinetobacter baumannii bacteremia in an intensive care unit[J]. J Korean Med Sci,2012,27(8):939-947.
[11] LIU C P,SHIH S C,WANG N Y,et al. Risk factors of mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia[J]. J Microbiol Immunol Infect,2016,49(6):934-940.
[12]张岩岩,朱婉,张静萍,等.多重耐药鲍曼不动杆菌血流感染危险因素分析[J].中国感染与化疗杂志,2017,17(2):134-139.
[13] GRANOV D,LJUBOVIC A D,ZEC S L,et al. The impact of antibiotic consumption on development of Acinetobacter baumannii resistance[J]. Mater Sociomed,2016,28(6):449-453.
[14]卫生部医政司. 2012年全国抗菌药物临床应用专项整治活动方案(节选)[J].中国社区医师(医学专业),2012,14(8):407.
[15] NOWAK P,PALUCHOWSKA P. Acinetobacter baumannii:Biology and drug resistance-role of carbapenemases[J]. Folia Histochem Cytobiol,2016,54(2):61-74.
[16] ZARRILLI R,POURNARAS S,GIANNOULI M,et al. Global evolution of multidrug-resistant Acinetobacter baumannii clonal lineages[J]. Int J Antimicrob Agents,2013,41(1):11-19.
[17] POURHAJIBAGHER M,HASHEMI F B,POURAKBARI B,et al.Antimicrobial resistance of Acinetobacter baumannii to imipenem in Iran:A systematic review and meta-analysis[J]. Open Microbiol J,2016,10:32-42.
[18]胡付品,郭燕,朱德妹,等. 2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[2] MUNOZ-PRICE L S,ROBERT A W. Acinetobacter Infection[J].N Engl J Med,2008,358(12):1271-1281.
[3] CHITTAWATANARAT K,JAIPAKDEE W,CHOTIROSNIRAMIT N,et al. Microbiology,resistance patterns,and risk factors of mortality in ventilator-associated bacterial pneumonia in a Northern Thai tertiary-care university based general surgical intensive care unit[J]. Infect Drug Resist,2014,7:203-210.
[4] ORSI G B,FRANCHI C,GIORDANO A,et al. Multidrug-resistant Acinetobacter baumannii outbreak in an intensive care unit[J]. J Chemother,2008,20(2):219-224.
[5] PELEG A Y,SEIFERT H,PATERSON D L. Acinetobacter baumannii:Emergence of a suceessful pathogen[J]. Clin Microbiol Rev,2008,21(3):538-582.
[6]高伟,张艳艳,刘双,等.重症监护病房鲍曼不动杆菌的耐药性分析[J].中华结核和呼吸杂志,2006,29(11):782.
[7] SOFIA M,ELPIS M,VIKTORIA E M,et al. A 5-year surveillance study on antimicrobial resistance of acinetobacter baumannii clinical isolates from a tertiary greek hospital[J]. Infect Chemother,2016,48(3):190-198.
[8]刘彦伶,毛静,贾蓓.鲍曼不动杆菌耐药及治疗进展[J].国外医药(抗生素分册),2015,36(2):63-67.
[9] ORSI G B,FRANCHI C,MARRONE R,et al. Laboratory confirmed bloodstream infection aetiology in an intensive care unit:Eight years study[J]. Ann Ig,2012,24(4):269-278.
[10] KIM S Y,JUNG J Y,KANG Y A,et al. Risk factors for occurrence and 30day mortality for carbapenem-resistant Acinetobacter baumannii bacteremia in an intensive care unit[J]. J Korean Med Sci,2012,27(8):939-947.
[11] LIU C P,SHIH S C,WANG N Y,et al. Risk factors of mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia[J]. J Microbiol Immunol Infect,2016,49(6):934-940.
[12]张岩岩,朱婉,张静萍,等.多重耐药鲍曼不动杆菌血流感染危险因素分析[J].中国感染与化疗杂志,2017,17(2):134-139.
[13] GRANOV D,LJUBOVIC A D,ZEC S L,et al. The impact of antibiotic consumption on development of Acinetobacter baumannii resistance[J]. Mater Sociomed,2016,28(6):449-453.
[14]卫生部医政司. 2012年全国抗菌药物临床应用专项整治活动方案(节选)[J].中国社区医师(医学专业),2012,14(8):407.
[15] NOWAK P,PALUCHOWSKA P. Acinetobacter baumannii:Biology and drug resistance-role of carbapenemases[J]. Folia Histochem Cytobiol,2016,54(2):61-74.
[16] ZARRILLI R,POURNARAS S,GIANNOULI M,et al. Global evolution of multidrug-resistant Acinetobacter baumannii clonal lineages[J]. Int J Antimicrob Agents,2013,41(1):11-19.
[17] POURHAJIBAGHER M,HASHEMI F B,POURAKBARI B,et al.Antimicrobial resistance of Acinetobacter baumannii to imipenem in Iran:A systematic review and meta-analysis[J]. Open Microbiol J,2016,10:32-42.
[18]胡付品,郭燕,朱德妹,等. 2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.