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目的了解鲍曼不动杆菌的分布及耐药率,为临床合理用药提供参考。方法对2011年1月至2013年12月从各类临床标本中分离的鲍曼不动杆菌进行统计分析。应用VITEK-2全自动细菌鉴定药敏仪进行菌株鉴定及药敏试验,参照2013年美国临床实验室标准化委员会(CLSI)标准判断药敏结果,以WHONET 5.6及SPSS 13.0统计软件进行数据分析。结果共检出780株鲍曼不动杆菌,科室分布居前的有重症监护室、呼吸科、皮肤科、胸外科及神经科,标本来源构成比居前的依次是痰液、分泌物及血液。其中共检出耐碳青霉烯类鲍曼不动杆菌(CRAB)120株,占15.38%,重症监护室的CRAB检出率显著高于其他科室(χ2=12.147,P<0.05);痰液来源的CRAB分离率比其余标本类型高(χ2=4.047,P<0.05)。共检出泛耐药鲍曼不动杆菌(XDRAB)26株,占3.33%,其中各科室及各标本来源间差异均无统计学意义(χ2=0.692,P>0.05;χ2=1.008,P>0.05)。除了对一代头孢菌素、氨苄西林等的天然耐药,鲍曼不动杆菌对二代头孢菌素、氨曲南及呋喃妥因耐药严重,均超过90.0%;其余的抗生素耐药率均在30.0%~50.0%,其中碳青霉烯类耐药率也达30.0%以上;左旋氧氟沙星的耐药率最低,为29.7%。重症监护室分离的鲍曼不动杆菌耐药最为严重,对以上药物耐药率均超过50.0%。结论鲍曼不动杆菌感染的标本来源与分离科室不同,CRAB检出率有差别,耐药率有较大差异,临床医师应根据药敏结果选择使用抗菌药物。
Objective To understand the distribution and drug resistance rate of Acinetobacter baumannii and provide a reference for clinical rational drug use. Methods The Acinetobacter baumannii isolated from clinical samples from January 2011 to December 2013 were analyzed statistically. VITEK-2 was used to identify the strain and susceptibility test. The drug susceptibility was judged according to CLSI standard in 2013, and data were analyzed by WHONET 5.6 and SPSS 13.0 software. Results A total of 780 strains of Acinetobacter baumannii were found. Among them, intensive care unit, respiratory department, dermatology, thoracic surgery and neurology were the most common among the departments. The source of the samples was sputum, secretions and blood . Among them, 120 strains of carbapenem-resistant Acinetobacter (CRAB) were detected, accounting for 15.38%. The CRAB detection rate in intensive care unit was significantly higher than that in other departments (χ2 = 12.147, P <0.05) The source CRAB separation rate than the other types of specimens (χ2 = 4.047, P <0.05). There were 26 strains of pan-drug-resistant Acinetobacter baumannii (XDRAB), accounting for 3.33% of them, of which there was no significant difference among different departments and sources (χ2 = 0.692, P> 0.05; χ2 = 1.008, P> 0.05). In addition to the first-generation cephalosporins, ampicillin and other natural resistance, Acinetobacter baumannii second-generation cephalosporins, aztreonam and nitrofurantoin resistance were more than 90.0%; the remaining antibiotic resistance rates were 30.0 % -50.0%, among which the resistance rate of carbapenems was above 30.0%; the resistance rate of levofloxacin was the lowest (29.7%). Acinetobacter baumannii isolated from intensive care unit was the most resistant, and the drug resistance rate to the above drugs was more than 50.0%. Conclusion The origin of Acinetobacter baumannii infection is different from that of the separate department. The detection rates of CRAB are different, and the rate of drug resistance is quite different. Clinicians should choose antibiotics based on their susceptibility results.