重症监护病房颅脑损伤患者多重耐药鲍曼不动杆菌耐药性变迁分析
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摘要
目的探讨多重耐药鲍曼不动杆菌耐药性在重症监护病房颅脑损伤患者中的变迁,为临床治疗提供依据。方法选取2015年1月至2017年12月收治的80例颅脑损伤患者作为研究对象,共采集包括痰、尿液、血液、分泌物等共380份样本,使用纸片扩散法对氨苄西林、阿米卡星、氨曲南、呋喃妥因、环丙沙星、头孢曲松、头孢西丁、头孢吡肟、亚胺培南、庆大霉素、左旋氧氟沙星、头孢唑啉、米诺环素、美罗培南、氨苄西林舒巴坦、头孢呋辛、复方新诺明、头孢哌酮、头孢他啶、头孢噻肟、哌拉西林、妥布霉素药敏情况进行测定。结果在2015年至2017年重症监护病房颅脑损伤患者体内分离出来的380份鲍曼不动杆菌标本中,80.00%以上均为痰液标本,其次分别为创面分泌液及血液样本。鲍曼不动杆菌的临床耐药率总体呈明显上升缺失,其中头孢曲松耐药率上升最为明显,且在2017年鲍曼不动杆菌对呋喃妥因及头孢喹啉的耐药率以达100%,且2017年除阿米卡星、米诺环素及头孢哌酮外,鲍曼不动杆菌的耐药率已超过50%。结论重症监护病房颅脑损伤住院患者鲍曼不动杆菌分离率逐渐降低,但其对抗生素耐药性逐年增长,多重耐药菌株诱发感染比例逐渐升高。
Objective To explore the drug resistance changes of multidrug resistantAcinetobacter baumannii in the patients with craniocerebral injury in intensive care unit(ICU) in order to provide the basis for clinical treatment.Methods A total of 80 patients with craniocerebral injury who were admitted and treated in our hospital from January 2015 to December 2017 were enrolled as the research objects. The 380 samples of sputum, urine, blood, secretions were collected. The drug sensitivity of ampicillin, amikacin, aztreonam, nitrofurantoin, ciprofloxacin, ceftriaxone, cefoxitin, cefepime, imipenem, gentamicin, levofloxacin, cefazolin, minocycline, meropenem, ampicillin sulbactam, cefuroxime, cotrimoxazole, cefoperazone, ceftazidime, cefotaxime, piperacillin, tobramycin were detected by the disk diffusion method.Results Among the 380 specimen of Acinetobacter baumannii which were isolated from the patients with craniocerebral injury in ICU from 2015 to 2017, the sputum specimens were more than 80%, next the secretion of wound surface and blood specimens. The clinical drug resistance rate of Acinetobacter baumannii was significantly increased, in which, the increase extent of ceftriaxone resistance rate was the most obvious,and the drug resistance rate of Acinetobacter baumannii to furadantin and cefquinoline reached 100% in 2017, moreover,except for amikacin,minocycline and cefoperazone,the drug resistance rate of Acinetobacter baumannii in 2017 was already more than 50%.Conclusion The isolation rate of Acinetobacter baumannii in hospitalized patients with craniocerebral injury in ICU is decreased gradually, but its resistance to antibiotics is increased year by year,and the proportion of multidrug resistant strain induced infection is increased gradually.
Objective To explore the drug resistance changes of multidrug resistantAcinetobacter baumannii in the patients with craniocerebral injury in intensive care unit(ICU) in order to provide the basis for clinical treatment.Methods A total of 80 patients with craniocerebral injury who were admitted and treated in our hospital from January 2015 to December 2017 were enrolled as the research objects. The 380 samples of sputum, urine, blood, secretions were collected. The drug sensitivity of ampicillin, amikacin, aztreonam, nitrofurantoin, ciprofloxacin, ceftriaxone, cefoxitin, cefepime, imipenem, gentamicin, levofloxacin, cefazolin, minocycline, meropenem, ampicillin sulbactam, cefuroxime, cotrimoxazole, cefoperazone, ceftazidime, cefotaxime, piperacillin, tobramycin were detected by the disk diffusion method.Results Among the 380 specimen of Acinetobacter baumannii which were isolated from the patients with craniocerebral injury in ICU from 2015 to 2017, the sputum specimens were more than 80%, next the secretion of wound surface and blood specimens. The clinical drug resistance rate of Acinetobacter baumannii was significantly increased, in which, the increase extent of ceftriaxone resistance rate was the most obvious,and the drug resistance rate of Acinetobacter baumannii to furadantin and cefquinoline reached 100% in 2017, moreover,except for amikacin,minocycline and cefoperazone,the drug resistance rate of Acinetobacter baumannii in 2017 was already more than 50%.Conclusion The isolation rate of Acinetobacter baumannii in hospitalized patients with craniocerebral injury in ICU is decreased gradually, but its resistance to antibiotics is increased year by year,and the proportion of multidrug resistant strain induced infection is increased gradually.
引文
1 Wang H,Wang J,Yu P,et al.Identification of antibiotic resistance genes in the multidrug-resistant Acinetobacter baumannii strain,MDR-SHH02,using whole-genome sequencing.International Journal of Molecular Medicine,2017,39:364.
2 王远芳,康梅.急诊科感染患者微生物标本送检及临床分离菌分布和耐药分析.中华急诊医学杂志,2016,25:429-432.
3 Ying J,Lu J,Zong L,et al.Molecular Epidemiology and Characterization of Genotypes of Acinetobacter baumannii Isolates from Regions of South China.Japanese Journal of Infectious Diseases,2016,69:180-185.
4 Yu JL,Chu ZP,Chang QF,et al.Pneumonia caused by extensive drug-resistant Acinetobacter baumannii among hospitalized patients:genetic relationships,risk factors and mortality.Bmc Infectious Diseases,2017,17:371.
5 张莉.重症监护室医院感染目标性监测结果分析及对策.中国药物与临床,2016,16:742-743.
6 Tsioutis C,Kritsotakis EI,Karageorgos SA,et al.Clinical epidemiology,treatment and prognostic factors of extensively drug-resistant Acinetobacter baumannii ventilator-associated pneumonia in critically ill patients.International Journal of Antimicrobial Agents,2016,48:492-497.
7 李小鹏,王治国.美国临床实验室标准化委员会标准与指南.中华检验医学杂志,2001,24:251-252.
8 He L,Lin M,Fan W,et al.Association of Single Nucleotide Polymorphisms in Toll-like Receptors with Acinetobacter baumanii Infectionin a Chinese Population.Iranian Journal of Public Health,2016,45:20-26.
9 Zang W.Analysis on the infections change and measures for the multiple drug-resistant bacteria of neurology.Pakistan Journal of Pharmaceutical Sciences,2016,29:1019.
10 郭桐宇,段宝京,李泽,等.抗菌药物使用与鲍曼不动杆菌耐药率的相关性分析.中国抗生素杂志,2016,41:710-717.
11 Cobos-Trigueros N,Solé M,Castro P,et al.Evaluation of a Mixing versus a Cycling Strategy of Antibiotic Use in Critically-Ill Medical Patients:Impact on Acquisition of Resistant Microorganisms and Clinical Outcomes.Plos One,2016,11:e0150274.
12 Al-Gethamy MM,Faidah HS,Adetunji HA,et al.Risk factors associated with multi-drug-resistant Acinetobacter baumannii nosocomial infections at a tertiary care hospital in Makkah,Saudi Arabia - a matched case-control study.Journal of International Medical Research,2017,45:1181.
13 Kuzi S,Blum SE,Kahane N,et al.Multi-drug-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii complex infection outbreak in dogs and cats in a veterinary hospital.Journal of Small Animal Practice,2016,57:617.
14 王亚丽,吴峰,胡锋,等.多重耐药鲍曼不动杆菌下呼吸道感染的临床特点及药敏分析.临床肺科杂志,2017,22:479-483.
15 Wei W,Yang H,Liu Y,et al.In vitro synergy of colistin combinations against extensively drug-resistant Acinetobacter baumannii producing OXA-23 carbapenemase.Journal of Chemotherapy,2016,28:159.
2 王远芳,康梅.急诊科感染患者微生物标本送检及临床分离菌分布和耐药分析.中华急诊医学杂志,2016,25:429-432.
3 Ying J,Lu J,Zong L,et al.Molecular Epidemiology and Characterization of Genotypes of Acinetobacter baumannii Isolates from Regions of South China.Japanese Journal of Infectious Diseases,2016,69:180-185.
4 Yu JL,Chu ZP,Chang QF,et al.Pneumonia caused by extensive drug-resistant Acinetobacter baumannii among hospitalized patients:genetic relationships,risk factors and mortality.Bmc Infectious Diseases,2017,17:371.
5 张莉.重症监护室医院感染目标性监测结果分析及对策.中国药物与临床,2016,16:742-743.
6 Tsioutis C,Kritsotakis EI,Karageorgos SA,et al.Clinical epidemiology,treatment and prognostic factors of extensively drug-resistant Acinetobacter baumannii ventilator-associated pneumonia in critically ill patients.International Journal of Antimicrobial Agents,2016,48:492-497.
7 李小鹏,王治国.美国临床实验室标准化委员会标准与指南.中华检验医学杂志,2001,24:251-252.
8 He L,Lin M,Fan W,et al.Association of Single Nucleotide Polymorphisms in Toll-like Receptors with Acinetobacter baumanii Infectionin a Chinese Population.Iranian Journal of Public Health,2016,45:20-26.
9 Zang W.Analysis on the infections change and measures for the multiple drug-resistant bacteria of neurology.Pakistan Journal of Pharmaceutical Sciences,2016,29:1019.
10 郭桐宇,段宝京,李泽,等.抗菌药物使用与鲍曼不动杆菌耐药率的相关性分析.中国抗生素杂志,2016,41:710-717.
11 Cobos-Trigueros N,Solé M,Castro P,et al.Evaluation of a Mixing versus a Cycling Strategy of Antibiotic Use in Critically-Ill Medical Patients:Impact on Acquisition of Resistant Microorganisms and Clinical Outcomes.Plos One,2016,11:e0150274.
12 Al-Gethamy MM,Faidah HS,Adetunji HA,et al.Risk factors associated with multi-drug-resistant Acinetobacter baumannii nosocomial infections at a tertiary care hospital in Makkah,Saudi Arabia - a matched case-control study.Journal of International Medical Research,2017,45:1181.
13 Kuzi S,Blum SE,Kahane N,et al.Multi-drug-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii complex infection outbreak in dogs and cats in a veterinary hospital.Journal of Small Animal Practice,2016,57:617.
14 王亚丽,吴峰,胡锋,等.多重耐药鲍曼不动杆菌下呼吸道感染的临床特点及药敏分析.临床肺科杂志,2017,22:479-483.
15 Wei W,Yang H,Liu Y,et al.In vitro synergy of colistin combinations against extensively drug-resistant Acinetobacter baumannii producing OXA-23 carbapenemase.Journal of Chemotherapy,2016,28:159.