2017-2024年某三甲医院重症医学科鲍曼不动杆菌耐药率变迁

Trends of drug resistance rate of Acinetobacter baumannii strains isolated from intensive care medicine department of a three-A hospital from 2017 to 2024

    摘要
  • 摘要:
    目的 对重症医学科(ICU)连续8年鲍曼不动杆菌(AB)检出情况和耐药率进行分析, 为临床合理用药和控制感染提供依据。
    方法 回顾分析2017-2024年常州市第一人民医院ICU中AB和耐碳青霉烯类鲍曼不动杆菌(CRAB)检出株数和标本分布, 并对耐药率变迁进行分析。
    结果 2017-2024年ICU共分离AB 2 078株，占比18.03%，各年份之间趋势变化无统计学差异(χ2=-1.573, P=0.116)；2017-2024年AB分离株主要来源于痰液(58.08%)和灌洗液(24.25%), 8年间痰标本比例逐渐下降(χ2=-8.257, P＜0.001), 灌洗液标本逐步上升(χ2=12.964, P＜0.001)；2017-2021年CRAB的检出率分别为91.48%、92.61%、92.56%、82.53%和52.44%, 呈逐年下降趋势, 2022-2024年又开始呈现上升趋势, 差异有统计学意义(χ2=-2.277, P=0.012)；其中痰液和灌洗液中CRAB的检出率均呈现下降后又上升的趋势(均P＜0.05)。AB对哌拉西林、米诺环素耐药率呈现缓慢上升趋势, 对庆大霉素、替加环素等的耐药率呈现下降趋势, 差异均有统计学意义(P＜0.05)；AB对亚胺培南、美罗培南等耐药率一直高于90%, 无变化趋势。
    结论 不动杆菌属是医院感染的重要病原菌, 近两年CRAB的检出率呈现下降后又反升的趋势。临床应规范痰培养送检, 增加无菌标本送检, AB对临床常用抗菌药物呈现较高的耐药性, 对于CRAB感染, 可以采用多黏菌素B、替加环素和米诺环素等抗菌药物治疗。

     

    Abstract:
    OBJECTIVE To observe the isolation rates and drug resistance rates of Acinetobacter baumannii strains isolated from intensive care unit (ICU) patients in 8 consecutive years so as to provide bases for reasonable clinical application of antibiotics and control of infections.
    METHODS The isolation rates and specimens from which the A. baumannii and carbapenem-resistant A. baumannii (CRAB) strains were isolated from ICU patients of the First People′s Hospital of Changzhou between 2017 and 2024 were retrospectively analyzed. The trends of the drug resistance rates were observed.
    RESULTS Totally 2078 (18.03%) strains of A. baumannii were isolated from the ICU patients from 2017 to 2024, and there was no significant difference in the changing trend among the years (χ2=-1.573, P=0.116). Among the A. baumannii strains that were isolated from 2017 to 2024, 58.08% were isolated from sputum, and 24.25% from lavage fluid specimens; the percentage of sputum specimens showed a downward trend in the 8 years (χ2=-8.257, P < 0.001), while the percentage of lavage fluid specimens showed an upward trend (χ2=12.964, P < 0.001). The isolation rate of the CRAB strains was 91.48% in 2017, 92.61% in 2018, 92.56% in 2019, 82.53% in 2020, 52.44% in 2021, showing a downward trend, and it began to rise in 2022-2024, there was significant difference (χ2=-2.277, P=0.012). The isolation rates of the CRAB strains from both sputum and lavage fluid specimens showed downward trends and then upward trends (all P < 0.05). The drug resistance rates of the A. baumannii strains to piperacillin and minocycline showed slow upward trends, while the drug resistance rates to gentamicin and tigecycline showed downward trends, and there were significant differences (P < 0.05). The drug resistance rates of the A. baumannii strains to imipenem and meropenem remained more than 90%.
    CONCLUSIONS Acinetobacter spp is the major pathogen causing the hospital-acquired infection. The isolation rate of CRAB strains shows a downward trend then a upward trend in recent two years. It is necessary for the hospital to standardize the submission of sputum specimens and increase the aseptic submission. The A. baumannii strains show high drug resistance rates to the commonly used antibiotics. Polymyxin B, tigecycline and minocycline are the major antibiotics for treatment of CRAB infection.

     

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