国际检验医学杂志
國際檢驗醫學雜誌
국제검험의학잡지
INTERNATIONAL JOURNAL OF LABORATORY MEDICINE
2014年
16期
2197-2199
,共3页
鲍曼不动杆菌%抗药性,微生物%抗菌药
鮑曼不動桿菌%抗藥性,微生物%抗菌藥
포만불동간균%항약성,미생물%항균약
Acinetobacter baumanii%drug resistance,microbial%anti-bacterial agents
目的：分析上海中医药大学附属曙光医院2008～2013年临床住院患者标本分离的鲍曼不动杆菌分布特点及其耐药情况，为临床合理应用抗菌药物提供依据。方法采用全自动微生物分析仪 BD phoenix-100对该院2008年9月至2013年9月临床分离的鲍曼不动杆菌进行菌种鉴定和最低抑菌浓度（MIC）测定，对所有数据进行分析。结果自2008年9月至2013年9月，历年分离的鲍曼不动杆菌依次为128、173、350、282、186株，以2012整年抽样查得临床分离的鲍曼不动杆菌菌株主要来源于痰标本（155株，68．28％）；病房主要集中于重症监护病房（65株，28．63％），其次是呼吸科（47株，20．70％）、急诊留观（35株，15．42％）、中风老年科病房（24株，10．57％），患者也多见于60岁以上老年人。根据5年内数据，多种不同抗菌药物的耐药率普遍增高，特别是2011～2012年间上升趋势更明显，青霉素类抗菌药物呈全耐药性。对第3、4代头孢菌素类、氨基糖苷类、喹诺酮类抗菌药物也表现普遍耐药。头孢菌素类（头孢他啶、头孢噻肟、头孢吡肟）抗菌药物耐药率保持在75．00％～85．00％较高水平，喹诺酮类（环丙沙星、左氧氟沙星）与氨基糖苷类（庆大霉素、阿米卡星）抗菌药物耐药率也呈逐年递增态势；对β-内酰胺类复方制剂耐药率增长速度较快，如氨苄西林/舒巴坦从60．16％增长至83．33％。其中碳青霉烯类抗菌药物亚胺培南、美洛培南耐药率增长幅度也非常明显，亚胺培南从25．20％上升最高到82．27％，并且检出率不断增加。舒普森由18．89％上升至80．00％，而唯一不同的是克里斯丁（多黏菌素 E）5年来一直保持低耐药率。结论鲍曼不动杆菌对各种抗菌药物的耐药性逐渐增强，多重耐药和泛耐药鲍曼不动杆菌分离率逐年增高，应警惕并高度重视该菌感染及耐药监测，以减少耐药菌株的产生和播散。
目的：分析上海中醫藥大學附屬曙光醫院2008～2013年臨床住院患者標本分離的鮑曼不動桿菌分佈特點及其耐藥情況，為臨床閤理應用抗菌藥物提供依據。方法採用全自動微生物分析儀 BD phoenix-100對該院2008年9月至2013年9月臨床分離的鮑曼不動桿菌進行菌種鑒定和最低抑菌濃度（MIC）測定，對所有數據進行分析。結果自2008年9月至2013年9月，歷年分離的鮑曼不動桿菌依次為128、173、350、282、186株，以2012整年抽樣查得臨床分離的鮑曼不動桿菌菌株主要來源于痰標本（155株，68．28％）；病房主要集中于重癥鑑護病房（65株，28．63％），其次是呼吸科（47株，20．70％）、急診留觀（35株，15．42％）、中風老年科病房（24株，10．57％），患者也多見于60歲以上老年人。根據5年內數據，多種不同抗菌藥物的耐藥率普遍增高，特彆是2011～2012年間上升趨勢更明顯，青黴素類抗菌藥物呈全耐藥性。對第3、4代頭孢菌素類、氨基糖苷類、喹諾酮類抗菌藥物也錶現普遍耐藥。頭孢菌素類（頭孢他啶、頭孢噻肟、頭孢吡肟）抗菌藥物耐藥率保持在75．00％～85．00％較高水平，喹諾酮類（環丙沙星、左氧氟沙星）與氨基糖苷類（慶大黴素、阿米卡星）抗菌藥物耐藥率也呈逐年遞增態勢；對β-內酰胺類複方製劑耐藥率增長速度較快，如氨芐西林/舒巴坦從60．16％增長至83．33％。其中碳青黴烯類抗菌藥物亞胺培南、美洛培南耐藥率增長幅度也非常明顯，亞胺培南從25．20％上升最高到82．27％，併且檢齣率不斷增加。舒普森由18．89％上升至80．00％，而唯一不同的是剋裏斯丁（多黏菌素 E）5年來一直保持低耐藥率。結論鮑曼不動桿菌對各種抗菌藥物的耐藥性逐漸增彊，多重耐藥和汎耐藥鮑曼不動桿菌分離率逐年增高，應警惕併高度重視該菌感染及耐藥鑑測，以減少耐藥菌株的產生和播散。
목적：분석상해중의약대학부속서광의원2008～2013년림상주원환자표본분리적포만불동간균분포특점급기내약정황，위림상합리응용항균약물제공의거。방법채용전자동미생물분석의 BD phoenix-100대해원2008년9월지2013년9월림상분리적포만불동간균진행균충감정화최저억균농도（MIC）측정，대소유수거진행분석。결과자2008년9월지2013년9월，력년분리적포만불동간균의차위128、173、350、282、186주，이2012정년추양사득림상분리적포만불동간균균주주요래원우담표본（155주，68．28％）；병방주요집중우중증감호병방（65주，28．63％），기차시호흡과（47주，20．70％）、급진류관（35주，15．42％）、중풍노년과병방（24주，10．57％），환자야다견우60세이상노년인。근거5년내수거，다충불동항균약물적내약솔보편증고，특별시2011～2012년간상승추세경명현，청매소류항균약물정전내약성。대제3、4대두포균소류、안기당감류、규낙동류항균약물야표현보편내약。두포균소류（두포타정、두포새우、두포필우）항균약물내약솔보지재75．00％～85．00％교고수평，규낙동류（배병사성、좌양불사성）여안기당감류（경대매소、아미잡성）항균약물내약솔야정축년체증태세；대β-내선알류복방제제내약솔증장속도교쾌，여안변서림/서파탄종60．16％증장지83．33％。기중탄청매희류항균약물아알배남、미락배남내약솔증장폭도야비상명현，아알배남종25．20％상승최고도82．27％，병차검출솔불단증가。서보삼유18．89％상승지80．00％，이유일불동적시극리사정（다점균소 E）5년래일직보지저내약솔。결론포만불동간균대각충항균약물적내약성축점증강，다중내약화범내약포만불동간균분리솔축년증고，응경척병고도중시해균감염급내약감측，이감소내약균주적산생화파산。
Objective To analyze the distribution characteristics and antimicrobial resistance of isolated Acinetobacter(A.)bau-mannii from the clinical inpatients in our hospital from 2008 to 2013 to provide the basis for rational use of antibacterial drugs in clinic.Methods The BD phoenix-100 fully automatic microbial analyzer(USA)was adopted to conduct the strain identification and the minimal inhibitory concentration(MIC)detection of clinically isolated A.baumannii.All obtained data were analyzed.Results 128,173,350,282,186 strains of A.baumannii in turn were isolated during these years,the strains in sampling from the clinically i-solated A.baumannii during 2012 was mainly originated from the sputum samples(155 strains,68.28%).In the distribution of hos-pital departments,most concentrated in ICU(65 strains,28.63%),followed by the respiratory department(47 strains,20.70%),the emergency observation wards(35 strains,15.42%)and the apoplexy and geriatric wards(24 strains,10.57%),the most of patients were older people aged more than 60 years.And according to the data within these 5 years,many kinds of different antibacterial drugs had generally the increased drug resistance rate,especially the increasing trend during 2011-2012 was more obvious,the pen-icillins all showed extensive drug-resistance.In the third,fourth generation cephalosporins,aminoglycosides and quinolones were generally drug-resistant.The drug resistance rate of cephalosporins(ceftazidime,cefotaxime,cefepime)remained at a higher level of 75.00%-85.00%.The drug resistance rate of quinolones(ciprofloxacin,levofloxacin)and aminoglycosides(gentamicin,amikacin) also showed the increasing trend year after year.The drug-resistant rate of the beta lactam compound preparations had the rapidly increasing speed,such as which of ampicillin /sulbactam was increased from 60.16% to 83.33%,which of carbapenems such as imipenem and meropenem was increased more significantly,the drug-resistant rate of imipenem was increased from 25.20% to 82.27%,and the detection rate was continually increased.And the drug resistant rate of Schupson was increased from 18.89% to 80%,but the only difference was the drug named Colistin(polymyxin E)maintained a low drug resistance rate during these five years.Conclusion Resistance of A.baumannii to various antibacterial drugs is gradually increased and the isolation rate of multi-drug-resistant and pan-drug resistant A.baumannii is increased year by year.So A.baumannii infection and its drug-resistance changes should be vigilant and be paid more attention to for preventing the emergence and spread of drug-resistant A.baumannii strains.
