摘要
目的评估神经外科鲍曼不动杆菌（ABA）的医院感染及耐药性情况。方法回顾性分析2012年1月至2017年9月陆军军医大学第一附属医院神经外科从住院患者标本中分离的ABA分布情况及其耐药性。采用最小抑菌浓度法，比较ABA对常见21种抗生素的耐药性。分析6年间ABA的耐药性变化趋势。结果2012-2017年共分离到鲍曼不动杆菌1420株，6年间神经外科检出的ABA占全科检出细菌的10．7％-23．9％；除2014年外，神经外科各年份ABA占检出细菌的比例均高于同年全院ABA所占的比例（8．4％～14．3％），其中2012、2013、2015、2017年比较，差异有统计学意义（均P〈0．01）。与2012年比较，2013-2017年ABA对青霉素类中的氨苄西林（均〉90．0％）和哌拉西林（65．3％～88．2％）的耐药率维持在较高水平（均P〈0．01）；而青霉素加酶抑制剂类的抗菌药物氨苄西林-舒巴坦（62．0％～80．7％）、哌拉西林-他唑巴坦（65．5％～78．0％）的耐药率相对较低，与氨苄西林和哌拉西林比较，差异有统计学意义（P〈0．01）。2013年后，ABA对头孢菌素类抗生素、亚胺培南和美罗培南的耐药率均超过65．0％；ABA对头孢哌酮一舒巴坦耐药率逐渐上升，2015年以后均超过50．0％。2012-2017年多耐药ABA的比例也呈逐年增高的趋势（36．3％～82．0％，P=0．000）。结论ABA在神经外科感染中所占比例不断增加，耐药性也在增强，应注意防控，参考细菌药敏结果合理用药。
Objective To study the situation of nosocomial infection and drug resistance of acinetobacter baumanniinii （ABA） at a neurosurgical center. Methods A retrospective analysis was conducted about the data of ABA and its rate of drug resistance from the inpatients at Department of Neurosurgery, the First Affiliated Hospital of Army Military Medical University from January 2012 to September 2017. The minimum inhibitory concentration method was used to compare the resistance of ABA to 21 common antibiotics. The change trend of drug resistance of ABA in the past 6 years was analyzed. Results A total of 1420 strains of ABA were isolated from 2012 to 2017. During the past 6 years, ABA detected at Department of Neurosurgery accounted for 10.7% - 23.9% of the total bacteria detected. The proportion of ABA detected at Department of Neurosurgery was higher than that at the whole hospital （8.4% -14.3% ）. Except for 2014, the difference was statistically significant in 2012, 2013, 2015 and 2017 （P 〈0.01 ）. Compared with 2012, the resistance rate of ABA to ampicillin （all 〉 90.0% ） and piperacillin （65.3% -88.2% ） of penicillins was maintained at a high level for 2013 -2017 years （P 〈 0. 01 ）, but the resistance of penicillin with enzyme inhibitor, such as ampicillin-sulbactam （62.0% - 80.7% ） and piperacillin-tazobactam （65.5% -78.0% ） , was relatively low. Compared with ampicillin and piperacillin, the difference was statistically significant （P 〈 0. 001 ）. After 2013, the resistance rates of ABA to cephalosporins, imipenem and meropenem exceeded 65%. The resistance rate of ABA to cefoperazone-sulbactam increased gradually and exceeded 50% after 2015. The proportion of multidrug-resistant ABA was also increasing year by year from 2012 to 2017 （36.3% - 82.0% , P = 0. 000 ）. Conclusions The proportions of ABA infection and its drug resistance at Department of Neurosurgery seem to be increasing. We should pay attention to prevention and control of those. Antibiotics need to be administered rationally with reference to the results of bacterial susceptibility.
作者
邹德伟
刘智勇
王俊伟
汪攀
潘金玉
江婷
吴南
Zou Dewei;Liu Zhiyong;Wang Junwei;Wang Pan;Pan Jinyu;Jiang Ting;Wu Nan(Department of Neurosurgery,the First Affiliated Hospital,Army Military Medical University,Chongqing 400038,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2018年第7期709-713,共5页
Chinese Journal of Neurosurgery
关键词
鲍氏不动杆菌
交叉感染
抗药性
Acinetobacter baumannii
Cross infection
Drug resistance
