江苏地区烧伤ICU鲍氏不动杆菌院内感染菌株的分布与耐药性监测
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摘要
目的明确江苏地区烧伤ICU鲍氏不动杆菌院内感染菌株的分布情况及耐药性特点,为临床预防和治疗鲍氏不动杆菌感染提供临床依据。方法采用回顾性分析方法,分析2013年1月-2015年12月入住江苏地区九家医院烧伤ICU发生鲍氏不动杆菌院内感染患者的临床资料,采集患者创面分泌物、痰液、尿液、血液等标本进行细菌培养和耐药性分析。结果 182例感染鲍氏不动杆菌患者,临床各类送检标本共检出鲍氏不动杆菌250株,其中伤口分泌物分离105株占42.00%,其次为痰液标本83株占33.20%;临床基本资料显示:烧伤ICU患者中男性患者、年龄<65岁、住院时间≥7d,使用广谱抗生素,患者占比较高,昏迷、使用机械通气及使用激素患者占比较低;临床药敏结果显示,烧伤ICU鲍氏不动杆菌对氨基糖苷类和部分复合酶抑制剂抗菌药物耐药率在52.40%以上、对头孢类抗菌药物耐药率在42.00%以上,对碳青霉烯类抗菌药物耐药率达43.60%,对左氧氟沙星耐药率最低为30.00%。结论鲍氏不动杆菌是烧伤ICU内检出率较高的条件致病菌,检出部位主要为创面分泌物,与大面积烧伤病情特点、入住烧伤ICU时间、使用广谱抗菌药物等因素相关,对常用抗菌药物耐药率较高。根据本地区的致病菌种及耐药情况合理选择抗菌药物,提高临床治疗效果,以减少烧伤ICU内鲍氏不动杆菌感染的发生率。
OBJECTIVE To understand the distribution and drug resistance of Acinetobacter baumannii strains isolated from the ICU burn patients with infection in Jiangsu so as to provide guidance for clinical prevention and treatment of A.baumannii infection.METHODS By means of retrospective survey,the clinical data of patients who had A.baumannii infection and were treated in burn ICUs of 9 hospitals in Jiangsu from Jan 2013 to Dec 2015 were analyzed.The wound secretions,urine,sputum and blood specimens were collected from the patients so as to conduct bacterial culture,and the drug resistance of the strains was observed.RESULTS A total of 250 strains of A.baumannii were isolated from various types of submitted specimens of 182 patients with A.baumannii infection,105(42.00%)of which were isolated from wound secretions,and 83(33.20%)were isolated from sputum specimens.The baseline clinical data of the patients showed that the proportions of male patients,the patients aged less than 65 years old and the patients with the length of hospital stay no less than 7 days were high,while the proportions of the patients who were treated with broad spectrum antibiotics,had coma,were treated with mechanical ventilation and hormones were relatively low.The result of drug susceptibility testing indicated that the drug resistance rates of the A.baumannii strains to aminoglycosides and some compound enzyme inhibitors were more than52.40%,the drug resistance rate to cephalosporins was more than 42.00%,the drug resistance rate to carbapenems was as high as 43.60%,and the drug resistance rate to levofloxacin was the lowest(30.00%).CONCLUSION The isolation rate of A.baumannii strains is high among the opportunistic pathogens isolated from the burn ICUs,the strains are mainly isolated from the wound secretions,which is associated with the large area of burns,length of burn ICU stay and use of broad spectrum antibiotics.The strains are highly resistant to the commonly used antibiotics.It is necessary to reasonably use antibiotics based on the species and drug resistance of the pathogens and improve the clinical therapeutic effect so as to reduce the incidence of A.baumannii infection in the burn ICUs.
OBJECTIVE To understand the distribution and drug resistance of Acinetobacter baumannii strains isolated from the ICU burn patients with infection in Jiangsu so as to provide guidance for clinical prevention and treatment of A.baumannii infection.METHODS By means of retrospective survey,the clinical data of patients who had A.baumannii infection and were treated in burn ICUs of 9 hospitals in Jiangsu from Jan 2013 to Dec 2015 were analyzed.The wound secretions,urine,sputum and blood specimens were collected from the patients so as to conduct bacterial culture,and the drug resistance of the strains was observed.RESULTS A total of 250 strains of A.baumannii were isolated from various types of submitted specimens of 182 patients with A.baumannii infection,105(42.00%)of which were isolated from wound secretions,and 83(33.20%)were isolated from sputum specimens.The baseline clinical data of the patients showed that the proportions of male patients,the patients aged less than 65 years old and the patients with the length of hospital stay no less than 7 days were high,while the proportions of the patients who were treated with broad spectrum antibiotics,had coma,were treated with mechanical ventilation and hormones were relatively low.The result of drug susceptibility testing indicated that the drug resistance rates of the A.baumannii strains to aminoglycosides and some compound enzyme inhibitors were more than52.40%,the drug resistance rate to cephalosporins was more than 42.00%,the drug resistance rate to carbapenems was as high as 43.60%,and the drug resistance rate to levofloxacin was the lowest(30.00%).CONCLUSION The isolation rate of A.baumannii strains is high among the opportunistic pathogens isolated from the burn ICUs,the strains are mainly isolated from the wound secretions,which is associated with the large area of burns,length of burn ICU stay and use of broad spectrum antibiotics.The strains are highly resistant to the commonly used antibiotics.It is necessary to reasonably use antibiotics based on the species and drug resistance of the pathogens and improve the clinical therapeutic effect so as to reduce the incidence of A.baumannii infection in the burn ICUs.
引文
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[5]俞云松.多药耐药鲍曼不动杆菌-21世纪革兰阴性菌的"MRSA"[J].中华临床感染病杂志,2009,2(2):65-67.
[6]中华人民共和国卫生部.医院感染诊断标准(试行)[J].现代实用医学,2003,15(7):460-465.
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[9]段秀杰,陆建成,阴晴,等.重症监护病房鲍曼不动杆菌感染调查及泛耐药情况分析[J].中国现代医学杂志,2010,20(2):244-247.
[10]儿童创伤急救早期处理专家共识组.儿童创伤急救早期处理专家共识[J].临床儿科杂志,2017,35(5):377-383.
[11]李峰,柴家科,常东.23例次烧伤病房创面感染鲍氏不动杆菌的临床分析[J].中华医院感染学杂志,2005,15(6):711-712.
[12]曾桂芬,刘行超,徐宝灵.466株鲍氏不动杆菌感染的临床分布与耐药性分析[J].中华医院感染学杂志,2011,21(2):367-368.
[13]邱瑶雪,李家斌,程君,等.2013-2015革兰阴性多药耐药菌的分布、耐药性及危险因素分析[J].中华医院感染学杂志,2017,27(5):980-983.
[2]Thakur K,Sharma G,Singh B,et al.Cationic-bilayered nanoemulsion of fusidic acid:an investigation on eradication of methicillin-resistant Staphylococcus aureus 33591infection in burn wound[J].Nanomedicine(Lond),2018,13(8):825-847.
[3]Latifi NA,Karimi H.Correlation of occurrence of infection in burn patients[J].Ann Burns Fire Disasters,2017,30(3):172-176.
[4]Wagenvoort JH,De Brauwer EI,Toenbreker HM,et al.Epidemic Acinetobacter baumannii strain with MRSA-like behaviour carried by healthcare staff[J].Eur J Clin Microbiol Infect Dis,2002,21(4):326-327.
[5]俞云松.多药耐药鲍曼不动杆菌-21世纪革兰阴性菌的"MRSA"[J].中华临床感染病杂志,2009,2(2):65-67.
[6]中华人民共和国卫生部.医院感染诊断标准(试行)[J].现代实用医学,2003,15(7):460-465.
[7]黎鳌.黎鳌烧伤学[M].上海:上海科学技术出版社,2001:12.
[8]尚红,王毓三,申子瑜.全国临床检验操作规程[M].4版.北京:人民卫生出版社,2014:720-721.
[9]段秀杰,陆建成,阴晴,等.重症监护病房鲍曼不动杆菌感染调查及泛耐药情况分析[J].中国现代医学杂志,2010,20(2):244-247.
[10]儿童创伤急救早期处理专家共识组.儿童创伤急救早期处理专家共识[J].临床儿科杂志,2017,35(5):377-383.
[11]李峰,柴家科,常东.23例次烧伤病房创面感染鲍氏不动杆菌的临床分析[J].中华医院感染学杂志,2005,15(6):711-712.
[12]曾桂芬,刘行超,徐宝灵.466株鲍氏不动杆菌感染的临床分布与耐药性分析[J].中华医院感染学杂志,2011,21(2):367-368.
[13]邱瑶雪,李家斌,程君,等.2013-2015革兰阴性多药耐药菌的分布、耐药性及危险因素分析[J].中华医院感染学杂志,2017,27(5):980-983.