鲍曼不动杆菌耐药性变迁与抗菌药物用药频度相关性分析
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摘要
目的分析我院鲍曼不动杆菌的耐药性变迁情况,及其与常见抗菌药物用药频度的相关性,为治疗鲍曼不动杆菌感染合理使用抗菌药物提供参考依据。方法采用法国VITEK-2 Compact全自动细菌鉴定仪对细菌进行培养鉴定及药效试验,监测2012—2016年临床分离的鲍曼不动杆菌对常见抗菌药物的耐药率,并对其耐药率变迁性与同期医院常用抗菌药物用药频度的相关性进行回顾性分析。结果 2012—2016年鲍曼不动杆菌分离率逐年升高,重症监护室(ICU)检出率最高,其对常见抗菌药物的耐药率均呈逐年升高趋势(P<0.01),除头孢哌酮/舒巴坦外,鲍曼不动杆菌对包括亚胺培南在内的常见抗菌药物耐药率均超过50%以上。鲍曼不动杆菌对亚胺培南的耐药性变迁与亚胺培南的用药频度呈明显正相关(r=0.919,P=0.027),但对其他常用抗菌药物的耐药性变迁与其用药频度均无相关性(P>0.05)。结论我院需要针对ICU和呼吸内科等重点科室加强对鲍曼不动杆菌的耐药监测和防控,建议根据药敏结果合理选用抗菌药物,严格限制和规范使用亚胺培南以降低鲍曼不动杆菌耐药率。
Objective To analyze the distribution and changes of antimicrobial resistance of Acinetobacter baumannii isolated from our hospital, and analyze the correlation between drug resistance and defined daily dose of antibiotics in order to provide references for guiding reasonable application of antibiotics clinically. Methods The bacterial identification and drug susceptibility testing were performed by VITEK-2 Compact of Biomeriex of France, the clinical distribution and changes of drug resistance of Acinetobacter baumannii to commonly used antibacterials were monitored, and the correlation between the drug resistance rates of Acinetobacter baumannii and defined daily dose of commonly used antibacterials were retrospectively analyzed in our hospital from 2012 to 2016. Results The isolation proportion of Acinetobacter baumannii was increasing. The most strains were from intensive care unit. The drug resistance of Acinetobacter baumannii to commonly used antibacterials showed an increasing tendency year by year(P<0.01). In addition to cefoperazone sulbactam, the resistance rate of Acinetobacter baumannii to all commonly used antibacterials including imipenem was over 50%. The changes of drug resistance rates of Acinetobacter baumannii to imipenem were positively correlated to the defined daily dose of imipenem(r=0.919, P=0.027), but there was not significant correlation between the changes of drug resistance of Acinetobacter baumannii to other commonly used antibacterials and their defined daily dose(P>0.05). Conclusion Our hospital should strengthen the monitoring and prevention to resistance rate of Acinetobacter baumannii in key departments such as intensive care unit and respiratory department, and reasonable use of antibiotics should be based on drug susceptibility testing. It needs to strictly limit and regulate the usage of imipenem so as to decrease the resistance rate of Acinetobacter baumannii.
Objective To analyze the distribution and changes of antimicrobial resistance of Acinetobacter baumannii isolated from our hospital, and analyze the correlation between drug resistance and defined daily dose of antibiotics in order to provide references for guiding reasonable application of antibiotics clinically. Methods The bacterial identification and drug susceptibility testing were performed by VITEK-2 Compact of Biomeriex of France, the clinical distribution and changes of drug resistance of Acinetobacter baumannii to commonly used antibacterials were monitored, and the correlation between the drug resistance rates of Acinetobacter baumannii and defined daily dose of commonly used antibacterials were retrospectively analyzed in our hospital from 2012 to 2016. Results The isolation proportion of Acinetobacter baumannii was increasing. The most strains were from intensive care unit. The drug resistance of Acinetobacter baumannii to commonly used antibacterials showed an increasing tendency year by year(P<0.01). In addition to cefoperazone sulbactam, the resistance rate of Acinetobacter baumannii to all commonly used antibacterials including imipenem was over 50%. The changes of drug resistance rates of Acinetobacter baumannii to imipenem were positively correlated to the defined daily dose of imipenem(r=0.919, P=0.027), but there was not significant correlation between the changes of drug resistance of Acinetobacter baumannii to other commonly used antibacterials and their defined daily dose(P>0.05). Conclusion Our hospital should strengthen the monitoring and prevention to resistance rate of Acinetobacter baumannii in key departments such as intensive care unit and respiratory department, and reasonable use of antibiotics should be based on drug susceptibility testing. It needs to strictly limit and regulate the usage of imipenem so as to decrease the resistance rate of Acinetobacter baumannii.
引文
[1]高健,李健民,张特立,等.2012-2015年鲍曼不动杆菌耐药率变迁及抗菌药物的选择[J].中国医院药学杂志,2017,37(6):562-565.
[2]冯锐,郑颖,高亚乾,等.我院鲍曼不动杆菌耐药率与同期抗菌药物用药频度相关性分析[J].河北医科大学学报,2017,38(1):72-75.
[3]黄晓波,张敏,龙恩武,等.我院2011年碳青霉烯类抗生素用药频度与鲍曼不动杆菌对其耐药率的相关性研究[J].中国药房,2012,23(30):2829-2830.
[4]余虹.某医院患者鲍曼不动杆菌感染临床分布及耐药性变迁[J].中国消毒学杂志,2015,32(2):119-123.
[5]高健,李健民,张特立,等.2012-2015年鲍曼不动杆菌耐药率变迁及抗菌药物选择[J].中国医院药学杂志,2017,37(6):562-565.
[6]赵心懋,任琳,宁永忠,等.某医院连续7年监测医院感染鲍曼不动杆菌耐药率变迁[J].中国消毒学杂志,2014,31(1):42-44
[7]赵建平,周秀岚.某院2009-2013年鲍曼不动杆菌临床分布及耐药性变迁[J].中国感染控制杂志,2015,14(2):85-88.
[8]付亚辉,黄飞,阳勇,等.某院近三年鲍曼不动杆菌临床分布级耐药性分析[J].吉林医学,2016,37(11):2638-2641.
[9]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.
[10]肖秀美,高爽,段京京,等.耐碳青霉烯鲍曼不动杆菌的耐药机制及分子流行病学[J].中国抗生素杂志,2017,42(8):704-710.
[11]Jung J Y,Park M S,Kim S E,et al.Risk factors for multidrugre-sistant Acinetobacter baumannii bacteremia in patients with colonization in the intensive care unit[J].BMC Infect Dis,2010,10(30):228-231.
[12]Jang T N,Lee S H,Huang C H,et al.Risk factors and impact of nosocomial Acinetobacter baumannii bloodstream infections in the adult intensive care unit:A case-control study[J].J Hosp Infect,2009,73(2):143-150.
[13]蒋福初,林书生,阙军.ICU重症患者医院获得性肺炎鲍曼不动杆菌感染高危因素及耐药性分析[J].江苏医药,2016,42(11):1292-1293.
[14]张红志,徐彦贵,卜一珊.ICU患者感染鲍曼不动杆菌的高危因素分析和治疗策略[J].山东医药,2015,(24):94-95.
[15]乔淑新,于云翔.呼吸内科病房泛耐药鲍曼不动杆菌的耐药性及临床用药分析[J].天津医药,2013,41(11):1126-1127.
[16]Lautenbach E,Synnestvedt M,Weiner M G,et al.Epidemiology and impact of imipenem resistance in Acinetobacter baumannii[J].Infect Control Hosp Epidemiol,2009,30(12):1186-1192.
[17]王珏鑫,余广超,温旺荣.鲍曼不动杆菌对碳青霉烯类抗菌药物耐药机制研究进展[J].中国抗生素杂志,2016,41(11):824-828.
[18]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[J].中国医药科学,2012,2(8):3-8.
[19]卫生部办公厅.多重耐药菌医院感染预防与控制技术指南(试行)[S].卫办医政发[2011]5号.
[2]冯锐,郑颖,高亚乾,等.我院鲍曼不动杆菌耐药率与同期抗菌药物用药频度相关性分析[J].河北医科大学学报,2017,38(1):72-75.
[3]黄晓波,张敏,龙恩武,等.我院2011年碳青霉烯类抗生素用药频度与鲍曼不动杆菌对其耐药率的相关性研究[J].中国药房,2012,23(30):2829-2830.
[4]余虹.某医院患者鲍曼不动杆菌感染临床分布及耐药性变迁[J].中国消毒学杂志,2015,32(2):119-123.
[5]高健,李健民,张特立,等.2012-2015年鲍曼不动杆菌耐药率变迁及抗菌药物选择[J].中国医院药学杂志,2017,37(6):562-565.
[6]赵心懋,任琳,宁永忠,等.某医院连续7年监测医院感染鲍曼不动杆菌耐药率变迁[J].中国消毒学杂志,2014,31(1):42-44
[7]赵建平,周秀岚.某院2009-2013年鲍曼不动杆菌临床分布及耐药性变迁[J].中国感染控制杂志,2015,14(2):85-88.
[8]付亚辉,黄飞,阳勇,等.某院近三年鲍曼不动杆菌临床分布级耐药性分析[J].吉林医学,2016,37(11):2638-2641.
[9]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.
[10]肖秀美,高爽,段京京,等.耐碳青霉烯鲍曼不动杆菌的耐药机制及分子流行病学[J].中国抗生素杂志,2017,42(8):704-710.
[11]Jung J Y,Park M S,Kim S E,et al.Risk factors for multidrugre-sistant Acinetobacter baumannii bacteremia in patients with colonization in the intensive care unit[J].BMC Infect Dis,2010,10(30):228-231.
[12]Jang T N,Lee S H,Huang C H,et al.Risk factors and impact of nosocomial Acinetobacter baumannii bloodstream infections in the adult intensive care unit:A case-control study[J].J Hosp Infect,2009,73(2):143-150.
[13]蒋福初,林书生,阙军.ICU重症患者医院获得性肺炎鲍曼不动杆菌感染高危因素及耐药性分析[J].江苏医药,2016,42(11):1292-1293.
[14]张红志,徐彦贵,卜一珊.ICU患者感染鲍曼不动杆菌的高危因素分析和治疗策略[J].山东医药,2015,(24):94-95.
[15]乔淑新,于云翔.呼吸内科病房泛耐药鲍曼不动杆菌的耐药性及临床用药分析[J].天津医药,2013,41(11):1126-1127.
[16]Lautenbach E,Synnestvedt M,Weiner M G,et al.Epidemiology and impact of imipenem resistance in Acinetobacter baumannii[J].Infect Control Hosp Epidemiol,2009,30(12):1186-1192.
[17]王珏鑫,余广超,温旺荣.鲍曼不动杆菌对碳青霉烯类抗菌药物耐药机制研究进展[J].中国抗生素杂志,2016,41(11):824-828.
[18]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[J].中国医药科学,2012,2(8):3-8.
[19]卫生部办公厅.多重耐药菌医院感染预防与控制技术指南(试行)[S].卫办医政发[2011]5号.