泛耐药鲍曼不动杆菌医院感染流行病学研究.doc

泛耐药鲍曼不动杆菌医院感染流行病学研究 王 振，黄文祥, 辛小娟，杨均均,史方静,刘成伟,李崇智 （400016 重庆，重庆医科大学附属第一医院感染科，重庆市传染病寄生虫病重点实验室） [摘要] 目的 调查分析我院医院内获得性鲍曼不动杆菌感染的流行特征，以及鲍曼不动杆菌的耐药性变迁，分析鲍曼不动杆菌感染爆发流行的原因和规律。方法 对我院2006-2009年4年间591例医院内获得性鲍曼不动杆菌感染的分布及耐药谱变迁进行系统性研究。用PFGE法对2009年包括对碳青霉烯耐药的102株多重耐药菌进行同源性分析，并用琼脂稀释法进行药敏试验，按CLSI(2009)标准判断细菌耐药性。结果 我院鲍曼不动杆菌医院感染主要集中于呼吸科、ICU、神经内科、胸心外科、神经外科。药敏试验结果显示鲍曼不动杆菌对常用抗生素耐药率逐年增加，其中对米诺环素、多西环素、多粘菌素耐药率较低，分别为43.7%、32.9%、2.5%。对碳青霉烯耐药上升较快，同时伴随该类药物用量明显上升。PFGE结果显示在ICU和呼吸科等病房存在A/B克隆株流行。结论 由于碳青霉烯类不合理应用和克隆株流行，导致医内泛耐药鲍曼氏不动杆菌感染率逐年增加, 临床应加强医院感染控制,合理使用抗生素,防治鲍曼不动杆菌感染。 [关键词] 鲍曼不动杆菌；抗生素；耐药性；医院感染 [中图法分类号] [文献标志码] A Epidemiological study on nosocomial infection of Acinetobacter. baumanii Wang Zeng, Huang Wenxiang, Xin Xiaojuan,Yang Junjun, Shi Fangjin, Liu Chenwei , Li Chongzhi (Department of Infectious Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing ,400016, China) [Abstract] Objective To investigate the epidemiological characteristics of nosocomial infection by acinetobacter baumannii and antibiotic resistance change in our hospital, analysis the reason that acinetobacter baumannii outbreak recently. In order to better guide the clinical use of antimicrobial agents reasonable. Methods To research the distribution of infection and the change of drug-resistant spectrum on 591 strains of Acintobacter baumannii isolated from our hospital during 2006 to 2009.The homology of 102 strains of CR-Ab in 2009 was studied by PFGE, Antimicrobial susceptibility testing was performed using broth micro dilution according to the NCCLS guidelines for MIC testing. Results The infection of Acinetobacter baumanii in our hospital was mainly distributed in pneumology department, intensive care units, neurology department, cardiac surgery and neurosurgery department. The drug resistance rate of Acinetobacter baumannii to common antimicrobial agents increased year by year, the resistance rate to Minocycline、Doxycycline 、polymyxin B was lowest (43.