危重症患者560株鲍曼不动杆菌的临床分布及药敏结果
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摘要
目的了解ICU患者鲍曼不动杆菌的检出率、分布及耐药状况,为临床ICU患者合理用药提供参考。方法对四川省人民医院急诊ICU、老年ICU、呼吸ICU、神经内科ICU、外科ICU送检的各类临床标本中分离的鲍曼不动杆菌进行系统分析。应用VITEK-2全自动细菌鉴定药敏仪并参照2013年美国临床实验室标准化委员会(CLISI)标准判断药敏结果,以WHONET5. 6及GRAPHPAD6. 0统计软件进行数据分析。结果 5年间5个ICU共检出560株鲍曼不动杆菌;鲍曼不动杆菌的检出率为急诊ICU36. 8%、老年ICU 20. 4%、呼吸ICU 12. 1%、神经内科ICU 8. 0%、外科ICU 22. 7%;痰液鲍曼不动杆菌检出率为70. 9%,血液12. 1%、其他17. 0%;抗菌药物敏感试验共检出耐碳青霉烯类鲍曼不动杆菌(CRAB) 236株,占42. 1%;老年ICU的耐碳青霉烯类鲍曼不动杆菌(CRAB)检出率为57. 9%,高于其他科室(P <0. 05)。共检出泛耐药鲍曼不动杆菌(XDRAB) 64株,占11. 4%,各科室标本中XDRAB检出率差异无统计学意义(P> 0. 05);对头孢他啶耐药率为40. 7%,头孢哌酮/舒巴坦耐药率为45. 0%,哌拉西林/他唑巴坦30. 5%,左旋氧氟沙星的耐药率为30. 1%,对替加环素耐药率为16. 8%。结论不同重症监护室因病人来源不同,其鲍曼不动杆菌检出率有明显差别,耐药率亦有较大差异。
Objective To investigate the detection rate,clinical distribution and drug resistance of Acinetobacter baumannii( Ab) in ICU patients in order to provide the basis for rational use antimicrobial drugs.Methods Ab strains were isolated from various clinical samples at 5 main ICU departments in the Sichuan Provincial People's Hospital and subjected to system analysis.VITEK-2 automatic bacteria identification system was used for bacteria identification and drug sensitivity,and the results of antimicrobial susceptibility were determined according to CLIS 2013 criteria.All the data were analyzed by WHONET 5. 6 and GRAPHPAD 6. 0.Results During the 5 years period,560 strains of Ab were detected.Among them,the detection rate in emergency intensive care unit was36. 8%,20. 4% in geriatric ICU,12. 1% in respiratory ICU,22. 7% in surgery ICU and 8. 0% in neurology ICU.The detection rate was70. 9% in sputum,12. 1% in blood sample and 17. 0% in other samples.There were 236 strains of CRAB detected by antimicrobial sensitivity test,accounting for 42. 1%.The detection rate of CRAB stains was 57. 9% in geriatrics ICU,which was higher than that in other ICUs( P < 0. 05).There were 64 strains of XDRAB were detected,accounting for 11. 4% but there was no significant difference among the departments and specimen types.The resistance rates of Ab to second generation ceftazibime was 40. 7%,to ampicillin sodium/ulbactam sodium was 45. 0%,to piperacillin sodium/tazobactam sodium were 30. 5% and to tolevo-ofloxaci was 30. 1%.The lowest resistance rate to Ab was tigecycline( 16. 8%).Conclusion The detection rate and resistance of Ab are different among departments.Clinicians should use antimicrobial drugs rationally.
Objective To investigate the detection rate,clinical distribution and drug resistance of Acinetobacter baumannii( Ab) in ICU patients in order to provide the basis for rational use antimicrobial drugs.Methods Ab strains were isolated from various clinical samples at 5 main ICU departments in the Sichuan Provincial People's Hospital and subjected to system analysis.VITEK-2 automatic bacteria identification system was used for bacteria identification and drug sensitivity,and the results of antimicrobial susceptibility were determined according to CLIS 2013 criteria.All the data were analyzed by WHONET 5. 6 and GRAPHPAD 6. 0.Results During the 5 years period,560 strains of Ab were detected.Among them,the detection rate in emergency intensive care unit was36. 8%,20. 4% in geriatric ICU,12. 1% in respiratory ICU,22. 7% in surgery ICU and 8. 0% in neurology ICU.The detection rate was70. 9% in sputum,12. 1% in blood sample and 17. 0% in other samples.There were 236 strains of CRAB detected by antimicrobial sensitivity test,accounting for 42. 1%.The detection rate of CRAB stains was 57. 9% in geriatrics ICU,which was higher than that in other ICUs( P < 0. 05).There were 64 strains of XDRAB were detected,accounting for 11. 4% but there was no significant difference among the departments and specimen types.The resistance rates of Ab to second generation ceftazibime was 40. 7%,to ampicillin sodium/ulbactam sodium was 45. 0%,to piperacillin sodium/tazobactam sodium were 30. 5% and to tolevo-ofloxaci was 30. 1%.The lowest resistance rate to Ab was tigecycline( 16. 8%).Conclusion The detection rate and resistance of Ab are different among departments.Clinicians should use antimicrobial drugs rationally.
引文
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[12]Talaga K,Krzy S'ciak P,Bulanda M. Susceptibility to tigecycline of Acinetobacter baumannii strains isolated from intensive care unit patients[J].Anaesthesiol Intensive Ther,2016,48(3):166-170.
[13]Ni W,Han Y,Zhao J,et al.Tigecycline treatment experience against multidrug-resistant Acinetobacter baumannii infections:a systematic review and meta-analysis[J].Int J Antimicrob Agents,2016,47(2):107-116.
[14]Zhen X,Chen Y,Hu X,et al.The difference in medical costs between carbapenem-resistant Acinetobacterbaumannii and non-resistant groups:a case study from a hospital in Zhejiang province,China[J].Eur J Clin Microbiol Infect Dis,2017,36(10):1989-1994.
[15]SzabóM,Kanász N,Darvas K,et al. Identification of risk factors of multiresistant infections on two intensive care units[J]. Orv Hetil,2017,158(32):1259-1268.
[2]Ni W. Tigecycline treatment experience against multidrug-resistant Acinetobacterbaumannii infections:a systematic review and meta-analysis[J].Int J Antimicrob Agents,2016,47(2):107-116.
[3]Nowak J,Zander E,Stefanik D,et al.High incidence of pandrug-resistant Acinetobacter baumannii isolates collected from patients with ventilator-associated pneumonia in Greece,Italy and Spain as part of the Magic Bullet clinical trial[J]. J Antimicrob Chemother,2017,72:3277-3282.
[4]Liang CA,Lin YC,Lu PL,et al.Antibiotic Strategies and Clinical Outcomes in Critically Ill Patients with Pneumonia Caused by Carbapenem-resistant Acinetobacter baumannii[J]. Clin Microbiol Infect,2017,3:30628-30634.
[5]Tuon FF,Rocha JL,Merlini AB.Combined therapy for multi-drug-resistant Acinetobacter baumannii infection--is there evidence outside the laboratory[J].J Med Microbiol,2015,64(9):951-959.
[6]Hu FP,Guo Y,Zhu DM,et al. Resistance trends among clinical isolates in China reported from CHINET surveillance of bacterial resistance,2005-2014[J]. Clin Microbiol Infect,2016,22(Suppl 1):S9-14.
[7]Li Y,Cao XL,Ge H,et al.A study on the targeted surveillance of nosocomial infection in intensive care units of 177 hospitals in Jiangsu Province of China[J].J Hosp Infect,2017,17:30549-30551.
[8]Agarwal S,Kakati B,Khanduri S,et al.Emergence of Carbapenem Resistant Non-Fermenting Gram-Negative Bacilli Isolated in an ICU of a Tertiary Care Hospital[J].J Clin Diagn Res,2017,11(1):1-16.
[9]Zafari M,Feizabadi MM,Jafari S,et al.High prevalence of OXA-type carbapenemases among Acinetobacter baumannii strains in a teaching hospital of Tehran[J].Acta Microbiol Immunol Hung,2017,5:1-10.
[10]Sathe P,Maddani S,Kulkarni S,et al.Management of ventilator associated pneumonia with a new antibiotic adjuvant entity(ceftriaxone+sulbactam+disodium edetate)-A novel approach to spare carbapenems[J].J Crit Care,2017,41:145-149.
[11]Gniadek TJ,Carroll KC,Simner PJ.Carbapenem-Resistant Non-Glucose-Fermenting Gram-Negative Bacilli:the Missing Piece to the Puzzle[J].J Clin Microbiol,2016,54(7):1700-1710.
[12]Talaga K,Krzy S'ciak P,Bulanda M. Susceptibility to tigecycline of Acinetobacter baumannii strains isolated from intensive care unit patients[J].Anaesthesiol Intensive Ther,2016,48(3):166-170.
[13]Ni W,Han Y,Zhao J,et al.Tigecycline treatment experience against multidrug-resistant Acinetobacter baumannii infections:a systematic review and meta-analysis[J].Int J Antimicrob Agents,2016,47(2):107-116.
[14]Zhen X,Chen Y,Hu X,et al.The difference in medical costs between carbapenem-resistant Acinetobacterbaumannii and non-resistant groups:a case study from a hospital in Zhejiang province,China[J].Eur J Clin Microbiol Infect Dis,2017,36(10):1989-1994.
[15]SzabóM,Kanász N,Darvas K,et al. Identification of risk factors of multiresistant infections on two intensive care units[J]. Orv Hetil,2017,158(32):1259-1268.