昆明地区烧伤病房鲍曼不动杆菌的耐药性和分子流行病学调查

摘要

目的：明确云南省烧伤中心病房鲍曼不动杆菌的分子流行病学及耐药特点，为临床预防和治疗鲍曼不动杆菌感染提供临床依据。方法采用细菌耐药监测软件WHONET5.6回顾分析云南省烧伤中心病房检出的鲍曼不动杆菌，应用脉冲场凝胶电泳对泛耐药鲍曼不动杆菌(PDR-Ab)进行同源性分析。结果烧伤中心病房鲍曼不动杆菌标本类型以创面分泌物培养最多，占71.4%；其次是血液标本占16.3%；痰液标本培养感染占10.1%；其他占2.1%。98株鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为82.2%和81.6%，除了米诺环素和头孢哌酮-舒巴坦为25%左右以外，对其他类抗菌药物的耐药率基本在90%以上。31株泛耐药鲍曼不动杆菌PFGE分型共分为A、B、C、D4型，其中A克隆16株，B克隆9株，C克隆4株，D克隆2株。结论昆明地区烧伤病房分离的鲍曼不动杆菌耐药性高，常常为多重耐药菌株或泛耐药菌株，但其对米诺环素、头孢哌酮/舒巴坦耐药率相对偏低，可作为临床治疗药物选择。本地区烧伤中心有泛耐药鲍曼不动杆菌流行，以A克隆为主。加强医护人员的感染控制观念，利用灵敏、可靠且分辨率强的分型技术进行PDR-Ab感染监控，对防止泛耐药鲍曼不动杆菌在烧伤病房爆发流行至关重要。%Objective To investigate the molecular epidemiology and drug-resistant features of Acinetobacter baumannii strains isolated from burn ward in Yunnan Burn Center and provide clinical basis for the prevention and treatment of Acinetobacter baumannii infection. Methods The retrospective analysis of Acinetobacter baumannii strains isolated from burn ward in Yunnan province was conducted using WHONET5.6 software. Homology analysis of the pan-drug resistant Ab were conducted by pulsed-field gel electrophoresis (PFGE). Results The wound secretion specimens were the most common specimen(71.4%), the blood was the second(16.3%), the positive rate of sputum specimens was 10.1%and other positive rate was 2.1%. The drug resistance rate of Acinetobaeter baumannii to imipenem and meropenem were 82.2% and 81.6%, respectively. The drug resistance rate of Acineto-baeter baumannii to most of antibacterials exceeded 90% in all drugs except minocycline and cefoperazone/sulbactam which had the drug resistance rate of 25%.The pan-drug resistant Ab were classified into 3 clones based on PFGE pattern. Conclusions Acinetobacter baumannii strains isolated from burn ward in Kunming have high levels of drug resistance to the antibiotic. The re-sistance rates of Acinetobacter baumannii to minocyline and cefoperazone/sulbactam were low, so these drugs can be used as a clinical therapeutic drug pan-drug resistance Acinetobaeter baumannii is spreading widely in burn ward of Kunming, the main-ly type is clone A. It is crucial that enhance the infection control implementation and utilize the PFGE genotyping system for the real-time surveillance and to prevent outbreak of PDR-Ab.