鲍曼不动杆菌感染的耐药性分析及治疗效果研究
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摘要
目的分析院内鲍曼不动杆菌的感染分布及耐药情况,指导临床合理用药。方法分析2017年7月至2018年6月医院鲍曼不动杆菌菌株临床分离情况及药物敏感性试验。将分离的耐碳青霉烯类菌株随机分为对照组和治疗组,两组均予以头孢哌酮钠舒巴坦钠治疗,治疗组加用硫酸阿米卡星治疗,比较两组的临床疗效。结果共分离522株鲍曼不动杆菌,主要来源于呼吸道(77. 01%);临床科室分布前3位依次为重症医学科(65. 13%)、神经外科(20. 11%)和呼吸科(7. 28%);鲍曼不动杆菌对头孢哌酮钠舒巴坦钠和硫酸阿米卡星最敏感;头孢曲松在2018年1月至6月的耐药性较2017年7月至12月明显升高(P <0. 05);头孢哌酮钠舒巴坦钠联合硫酸阿米卡星疗效明显高于单用头孢哌酮钠舒巴坦钠(P <0. 05)。结论鲍曼不动杆菌感染最严重的科室是重症医学科,头孢哌酮钠舒巴坦钠、硫酸阿米卡星较敏感,对多数临床常用抗菌药物普遍高度耐药,治疗时应根据药物敏感性试验结果合理选用。
Objective To analyze the distribution and drug resistance of Acinetobacter baumannii in the hospital in order to guide rational drug use in the clinic. Methods The clinical isolation and drug sensitivity test of Acinetobacter baumannii strains in our hospital from July 2017 to June 2018 were analyzed. The isolated carbapenem-resistant strains were randomly divided into the control group and the treatment group. Both groups were treated with cefoperazone sodium and sulbactam sodium,on this basis,the treatment group was treated with amikacin sulfate. The clinical efficacy in the two groups was compared. Results Totally 522 Acinetobacter baumannii strains were isolated,which mainly from respiratory tracts( 77. 01%). The top three clinical departments were Intensive Care Unit( 65. 13%),Department of Neurosurgery( 20. 11%) and Department of Respiratory( 7. 28%). Acinetobacter baumannii was most sensitive to cefoperazone sodium and sulbactam sodium and amikacin sulfate. The drug resistance of ceftriaxone from January to June 2018 was significantly higher than that from July to December 2017( P < 0. 05). The efficacy of cefoperazone sodium and sulbactam sodium combined with amikacin sulfate was significantly higher than that of cefoperazone sodium and sulbactam sodium alone( P < 0. 05).Conclusion Acinetobacter baumannii infection is most serious in the Intensive Care Unit. Cefoperazone sodium and sulbactam sodium and amikacin sulfate are more sensitive and generally high resistance to most commonly used antibiotics. Reasonable antibiotics should be selected according to the results of drug sensitivity in the treatment of Acinetobacter baumannii.
Objective To analyze the distribution and drug resistance of Acinetobacter baumannii in the hospital in order to guide rational drug use in the clinic. Methods The clinical isolation and drug sensitivity test of Acinetobacter baumannii strains in our hospital from July 2017 to June 2018 were analyzed. The isolated carbapenem-resistant strains were randomly divided into the control group and the treatment group. Both groups were treated with cefoperazone sodium and sulbactam sodium,on this basis,the treatment group was treated with amikacin sulfate. The clinical efficacy in the two groups was compared. Results Totally 522 Acinetobacter baumannii strains were isolated,which mainly from respiratory tracts( 77. 01%). The top three clinical departments were Intensive Care Unit( 65. 13%),Department of Neurosurgery( 20. 11%) and Department of Respiratory( 7. 28%). Acinetobacter baumannii was most sensitive to cefoperazone sodium and sulbactam sodium and amikacin sulfate. The drug resistance of ceftriaxone from January to June 2018 was significantly higher than that from July to December 2017( P < 0. 05). The efficacy of cefoperazone sodium and sulbactam sodium combined with amikacin sulfate was significantly higher than that of cefoperazone sodium and sulbactam sodium alone( P < 0. 05).Conclusion Acinetobacter baumannii infection is most serious in the Intensive Care Unit. Cefoperazone sodium and sulbactam sodium and amikacin sulfate are more sensitive and generally high resistance to most commonly used antibiotics. Reasonable antibiotics should be selected according to the results of drug sensitivity in the treatment of Acinetobacter baumannii.
引文
[1]俞善春,葛冰磊. 162株鲍曼不动杆菌的临床分布及耐药性分析[J].国际检验医学杂志,2014,35(23):3224-3225.
[2] GONZALEZ-VILLORIA AM,VALVERDE-GARDUNO V.Antibiotic-resistant Acinetobacter baumannii increasing success remains a challenge as a nosocomial pathogen[J]. J Pathogens,2016,2016(4):7318075-7318084.
[3]卫生部医政司.全国临床检验操作规程[M].第3版.南京:东南大学出版社,2006:89-95.
[4]范婷婷,苏丹虹. 2013年广州医科大学附属第一医院细菌耐药性监测[J].国际检验医学杂志,2014,35(13):1722-1725.
[5]胡向国,余广超,刘菊珍. 2010-2016年我院鲍曼不动杆菌的耐药性分析[J].中国抗生素杂志,2017,42(7):592-595.
[6]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.
[7]谭红娟,谭守勇,邝浩斌,等.结核病院呼吸道分离鲍曼不动杆菌构成比及耐药趋势分析[J].广东医学,2015,36(12):1822-1825.
[8]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.
[9]侯芳,郑波,吕媛. 2012年度全国细菌耐药监测报告:三级医院非重症监护病房住院患者的细菌耐药监测[J].中国临床药理学杂志,2015,31(11):964-969.
[10]刘一力,石毅. 2010-2014年鲍曼不动杆菌临床分布及耐药性分析[J].国际检验学杂志,2015,36(13):1899-1904.
[11]陈约慧,陈若飞,詹玲玲,等.头孢哌酮/舒巴坦对临床常见革兰阴性杆菌抗菌活性的研究[J].中华医院感染学杂志,2016,26(21):4855-4858.
[12]王勋松,徐长辉,袁水斌,等.头孢哌酮/舒巴坦对常见革兰阴性杆菌的体外抗菌作用[J].实验与检验医学,2012,30(6):595-596.
[13]曹雁,胡昭宇,赵德军,等.头孢他啶联合阿米卡星对多重耐药的鲍曼不动杆菌的体外抗菌作用分析[J].中国微生态学杂志,2011,23(10):926-928.
[2] GONZALEZ-VILLORIA AM,VALVERDE-GARDUNO V.Antibiotic-resistant Acinetobacter baumannii increasing success remains a challenge as a nosocomial pathogen[J]. J Pathogens,2016,2016(4):7318075-7318084.
[3]卫生部医政司.全国临床检验操作规程[M].第3版.南京:东南大学出版社,2006:89-95.
[4]范婷婷,苏丹虹. 2013年广州医科大学附属第一医院细菌耐药性监测[J].国际检验医学杂志,2014,35(13):1722-1725.
[5]胡向国,余广超,刘菊珍. 2010-2016年我院鲍曼不动杆菌的耐药性分析[J].中国抗生素杂志,2017,42(7):592-595.
[6]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.
[7]谭红娟,谭守勇,邝浩斌,等.结核病院呼吸道分离鲍曼不动杆菌构成比及耐药趋势分析[J].广东医学,2015,36(12):1822-1825.
[8]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.
[9]侯芳,郑波,吕媛. 2012年度全国细菌耐药监测报告:三级医院非重症监护病房住院患者的细菌耐药监测[J].中国临床药理学杂志,2015,31(11):964-969.
[10]刘一力,石毅. 2010-2014年鲍曼不动杆菌临床分布及耐药性分析[J].国际检验学杂志,2015,36(13):1899-1904.
[11]陈约慧,陈若飞,詹玲玲,等.头孢哌酮/舒巴坦对临床常见革兰阴性杆菌抗菌活性的研究[J].中华医院感染学杂志,2016,26(21):4855-4858.
[12]王勋松,徐长辉,袁水斌,等.头孢哌酮/舒巴坦对常见革兰阴性杆菌的体外抗菌作用[J].实验与检验医学,2012,30(6):595-596.
[13]曹雁,胡昭宇,赵德军,等.头孢他啶联合阿米卡星对多重耐药的鲍曼不动杆菌的体外抗菌作用分析[J].中国微生态学杂志,2011,23(10):926-928.