目的：探讨耐碳青霉烯类鲍曼不动杆菌（CRAB）临床分布特点与耐药情况，为临床合理使用抗菌药物、CRAB 感染的治疗及其医院感染的防控提供参考依据。方法回顾性分析2009年1月—2013年12月临床标本分离的 CRAB 临床资料，应用 WHONET 5．5软件统计其标本分布和耐药情况。结果5年共分离鲍曼不动杆菌（AB）标本888株，检出 CRAB 421株，检出率为47．4％，其中2011、2012和2013年检出率均在50．0％左右；标本来源以痰为主，占73．4％；科室分布以重症监护室（ICU）为主，占61．3％，其次是神经外科病房，为12．4％。CRAB 呈现高度耐药性，除头孢噻肟和头孢曲松外，CRAB 对检测的其他抗菌药物（头孢他啶、头孢吡肟、头孢哌酮／舒巴坦、氨曲南、亚胺培南、阿米卡星、庆大霉素、米诺环素、氯霉素、左氧氟沙星、环丙沙星、复方磺胺甲口恶唑）耐药率均高于非 CRAB，差异均有统计学意义（均 P ≤0．01）；5年来对头孢哌酮／舒巴坦耐药率最低（＜15％），其次是米诺环素，对其余抗菌药物耐药率多＞80．0％。结论应继续加强 CRAB 监测，重点关注 ICU 及呼吸系统医院感染的预防控制。%Objective To investigate the distribution characteristics and antimicrobial resistance of carbapenem-resistantAcinetobacter baumannii (CRAB),and to guide effective clinical prevention and rational antimicrobial use. Methods Data about clinically isolated CRAB between January 2009 and December 2013 were analyzed retrospec-tively,distribution and antimicrobial resistance were analyzed by WHONET 5.5 software.Results A total of 888 Acinetobacter baumannii strains were isolated,421 of which were CRAB,the isolation rate was 47.4%,the isola-tion rates in 2011 ,2012 and 2013 were all about 50.0%;CRAB strains were mainly isolated from sputum (73.4%) and mostly distributed in intensive care unit (ICU)(61 .3%),followed by neurosurgery department (12.4% ). CRAB presented highly antimicrobial resistance.Except cefotaxime and cefatriaxone,resistant rates of CRAB to the other detected antimicrobial agents(ceftazidime,cefepime,cefoperazone/sulbactam,aztreonam,imipenem,amika-cin,gentamycin,minocycline,chloramphenicol,levofloxacin,ciprofloxacin,and compound sulfamethoxazole)were all higher than non-CRAB isolates(all P ≤0.01),Compared with non-CRAB isolates,The resistant rate of CRAB to cefoperazone/sulbactam was the lowest(<15%),followed by minocycline,resistant rates to other antimicrobial agents were all >80.0%.Conclusion Surveillance of CRAB should be further strengthened.It is necessary to fo-cus on the control and prevention of healthcare-associated infection in ICU patients and respiratory system.
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