痰标本中耐亚胺培南鲍曼不动杆菌检出变化趋势及耐药性

摘要

目的：了解痰中耐亚胺培南鲍曼不动杆菌（IRAB）检出情况、耐药性及病区分布。方法回顾性分析2009年1月1日—2013年9月30日某院痰标本分离的鲍曼不动杆菌（AB），比较 IRAB 和非 IRAB 的病区分布、耐药性，以及 IRAB 检出率的变化趋势。结果痰中共检出 AB 711株，其中 IRAB 442株，非 IRAB 269株。AB 主要分布在重症监护病房（ICU，39．10％）和神经内科（25．18％）；ICU 检出 IRAB 254株（占57．47％），多于非 IRAB （24株，占8．92％），差异有统计学意义（χ2＝165．50，P ＜0．05）；IRAB 的检出率：ICU （91．37％）高于非 ICU （43．42％），差异有统计学意义（χ2＝257．29，P ＜0．05）。2009—2013年 IRAB 的检出率持续升高（分别为25．30％、36．36％、74．68％、65．56％和90．07％）。IRAB 对阿米卡星的耐药率较低（27．25％），非 IRAB 对阿米卡星和哌拉西林／他唑巴坦的耐药率较低（7．31％、8．24％）；除复方磺胺甲口恶唑外，IRAB 对其他抗菌药物的耐药率均高于非IRAB，差异均有统计学意义（均 P ＜0．05）。结论痰中 IRAB 检出率和耐药率均较高，临床应做到早培养、早治疗、早隔离，减少医院多重耐药菌的产生。%Objective To realize detection,antimicrobial resistance,and ward distribution of imipenem-resistant Acinetobacter baumannii (IRAB )from sputum.Methods AB strains isolated from sputum specimens in a hospital between January 1 ,2009 and September 30,2013 were analyzed retrospectively.Ward distribution,antimicrobial resistance,and isolation rates between IRAB and non-IRAB strains were compared.Results 711 AB strains were isolated from sputum,442 of which were IRAB,269 were non-IRAB.AB were mainly distributed in intensive care unit(ICU,39.10%)and neurology department (25.18%);detection rate of IRAB was significantly higher than non-IRAB in ICU (57.47%[n=254]vs 8.92%[n=24],χ2 =165.50,P <0.05),detection rate of IRAB in ICU was significantly higher than non-ICU (91 .37% vs 43.42%,χ2 =257.29,P <0.05).Detection rates of IRAB in 2009-2013 increased continuously (25.30%,36.36%,74.68%,65.56%,and 90.07%,respectively).The resistant rate of IRAB to amikacin was low (27.25%),resistant rates of non-IRAB to amikacin and piperacillin/tazobactam were both low (7.31 % and 8.24% respectively);except compound sulfamethoxazole,resistant rates of IRAB to other antimicrobial agents were all significantly higher than non-IRAB strains (all P < 0.05 ).Conclusion The detection rate and drug resistant rate of IRAB from sputum are both high,early culture,early treatment,and early isolation should be carried out to reduce the emergence of multidrug-resistant organisms.