2010～2017年山东省ICU鲍曼不动杆菌及肺炎克雷伯菌耐药情况
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摘要
目的了解山东省34所医院ICU临床分离鲍曼不动杆菌及肺炎克雷伯菌的耐药性变化趋势,为指导临床抗菌药物合理的应用提供依据。方法对2010年1月1日～2017年12月31日山东省ICU细菌耐药监测协作网平台34所医院分离的鲍曼不动杆菌及肺炎克雷伯菌进行回顾性分析,采用纸片扩散法(K-B法)做药物敏感试验,根据CLSI(2016版)判定药敏结果,采用WHONET5.6软件进行统计分析。结果共分离病原菌87 542株,其中鲍曼不动杆菌25 299株(28.90%)、肺炎克雷伯菌13 538株(15.46%)。鲍曼不动杆菌和肺炎克雷伯菌8年检出率均呈增加趋势,其标本来源以呼吸道标本为主,分别为84.33%和79.59%,其次是血标本、尿标本、引流液标本、伤口渗液和脑脊液。鲍曼不动杆菌对米诺环素、头孢哌酮/舒巴坦、美罗培南、亚胺培南、哌拉西林/他唑巴坦、头孢吡肟、头孢他啶的耐药率均呈上升趋势;肺炎克雷伯菌对美罗培南、亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦的耐药率均呈逐年增高趋势,但对阿米卡星有下降趋势。结论 2010～2017年,山东省ICU感染鲍曼不动杆菌及肺炎克雷伯菌对常用抗菌药物耐药率呈总体上升趋势,尤其对碳青霉烯类抗菌药的耐药情况日趋严重。
Objective To investigate the changes of drug resistance of Acinetobacter baumannii and Klebsiella pneumoniae in intensive care unit(ICU) of 34 hospitals in Shandong Province and to provide a basis for the rational uses of clinical antibacterial drugs.Methods The isolated date of Acinetobacter baumannii and Klebsiella pneumoniae collected from January 1, 2010 to December 31, 2017 were retrospective analyzed in 34 hospitals from Shandong ICU Bacterial Resistance Monitoring and Collaboration Network Platform. We used Kirby-Bauer method(K-B method) to test drug sensitivity, and determined the drug sensitivity by CLSI(2016 edition), and used software WHONET5.6 for statistical analysis. Results A total of 87 542 cases of pathogenic bacteria were isolated with 25 299(28.90%) of Acinetobacter baumannii and 13 538(15.46%) of Klebsiella pneumoniae. The 8-year detection rates of Acinetobacter baumannii and Klebsiella pneumoniae increased, and the specimens were mainly from respiratory specimens, which were 84.33% and 79.59%, respectively, followed by blood specimens, urine specimens, drainage specimens, wound seepage, and cerebrospinal fluid. The drug resistance rates of Acinetobacter baumannii to minocycline, cefoperazone/sulbactam, meropenem, imipenem, piperacillin/tazobactam, cefepime and ceftazidime were on the rise; the drug resistance rates of Klebsiella pneumonia to meropenem, imipenem, cefoperazone/sulbactam, piperacillin/tazobactin increased year by year, but it had an downward trend to amikacin. Conclusions From 2010 to 2017, the resistance rates of Acinetobacter baumannii and Klebsiella pneumoniae to common antibacterial drugs in ICU of Shandong Province showed an overall upward trend, especially the resistance to carbapenems.
Objective To investigate the changes of drug resistance of Acinetobacter baumannii and Klebsiella pneumoniae in intensive care unit(ICU) of 34 hospitals in Shandong Province and to provide a basis for the rational uses of clinical antibacterial drugs.Methods The isolated date of Acinetobacter baumannii and Klebsiella pneumoniae collected from January 1, 2010 to December 31, 2017 were retrospective analyzed in 34 hospitals from Shandong ICU Bacterial Resistance Monitoring and Collaboration Network Platform. We used Kirby-Bauer method(K-B method) to test drug sensitivity, and determined the drug sensitivity by CLSI(2016 edition), and used software WHONET5.6 for statistical analysis. Results A total of 87 542 cases of pathogenic bacteria were isolated with 25 299(28.90%) of Acinetobacter baumannii and 13 538(15.46%) of Klebsiella pneumoniae. The 8-year detection rates of Acinetobacter baumannii and Klebsiella pneumoniae increased, and the specimens were mainly from respiratory specimens, which were 84.33% and 79.59%, respectively, followed by blood specimens, urine specimens, drainage specimens, wound seepage, and cerebrospinal fluid. The drug resistance rates of Acinetobacter baumannii to minocycline, cefoperazone/sulbactam, meropenem, imipenem, piperacillin/tazobactam, cefepime and ceftazidime were on the rise; the drug resistance rates of Klebsiella pneumonia to meropenem, imipenem, cefoperazone/sulbactam, piperacillin/tazobactin increased year by year, but it had an downward trend to amikacin. Conclusions From 2010 to 2017, the resistance rates of Acinetobacter baumannii and Klebsiella pneumoniae to common antibacterial drugs in ICU of Shandong Province showed an overall upward trend, especially the resistance to carbapenems.
引文
[1] 朱任媛,张小江,杨启文,等.卫生部全国细菌耐药监测网2011年ICU来源细菌耐药监测[J].中国临床药理学杂志,2012,28(12):905-909.
[2] 张静,王翠翠,金炎,等.山东省101所医院重症监护病房患者分离细菌及耐药性特征[J].中国感染控制杂志,2017,16(6):521-526.
[3] D′Arezzo S, Lanini S, Puro V, et al. High-level tolerance to triclosan may play a role in Pseudomonas aeruginosa antibiotic resistance in immunocompromised hosts: evidence from outbreak investigation[J]. BMC Res Notes, 2012,5:43.
[4] 郭主声,朱学海,林偲思,等.重症监护病房病原菌分布及耐药性分析[J].国际检验医学杂志,2014,35(3):286-289.
[5] 高春波,苏丽菊,韩笑,等.铜绿假单胞菌和鲍曼不动杆菌感染分布特征及耐药性分析[J].国际检验医学杂志,2016,37(19):2682-2684.
[6] 詹玲玲,黄海霞,陈约慧,等.2013年至2015年1830株肺炎克雷伯菌感染的临床分布及耐药性分析[J].中国临床药理学杂志,2017,33(24):2575-2579.
[7] Hu FP, Guo Y, Zhu DM, et al. Resistance trends among clinical isolates in China reported from CHINET surveillance of bacterial resistance, 2005-2014[J]. Clin Microbiol Infect, 2016,22 Suppl 1:S9-14.
[8] 胡付品,郭燕,朱德妹,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251.
[9] 方全凤.ICU鲍曼不动杆菌感染原因分析和护理对策[J].基层医学论坛,2014,18(3):300-302.
[10] 张辉,张小江,徐英春,等.2005—2014年CHINET不动杆菌属细菌耐药性监测[J].中国感染与化疗杂志,2016,16(4):429-436.
[11] 汪红,胡龙华,宁长秀,等.耐碳青霉烯类抗生素鲍曼不动杆菌耐药机制的研究[J].中国临床药理学与治疗学,2014,19(10):1093-1098.
[12] Vardakas KZ, Tansarli GS, Rafailidis PI. Carbapenems versus alternative antibiotics for the treatment of bacteraemia due to Enterobacteriaceae producing extended-spectrum β-lactamases: a systematic review and meta-analysis[J]. J Antimicrob Chemother, 2012,67:2793-2803.
[13] 王云凤,姜雪.重症医学科病人标本分离鲍曼不动杆菌耐药谱变迁[J].中国消毒学杂志,2014,31(12):1307-1309.
[2] 张静,王翠翠,金炎,等.山东省101所医院重症监护病房患者分离细菌及耐药性特征[J].中国感染控制杂志,2017,16(6):521-526.
[3] D′Arezzo S, Lanini S, Puro V, et al. High-level tolerance to triclosan may play a role in Pseudomonas aeruginosa antibiotic resistance in immunocompromised hosts: evidence from outbreak investigation[J]. BMC Res Notes, 2012,5:43.
[4] 郭主声,朱学海,林偲思,等.重症监护病房病原菌分布及耐药性分析[J].国际检验医学杂志,2014,35(3):286-289.
[5] 高春波,苏丽菊,韩笑,等.铜绿假单胞菌和鲍曼不动杆菌感染分布特征及耐药性分析[J].国际检验医学杂志,2016,37(19):2682-2684.
[6] 詹玲玲,黄海霞,陈约慧,等.2013年至2015年1830株肺炎克雷伯菌感染的临床分布及耐药性分析[J].中国临床药理学杂志,2017,33(24):2575-2579.
[7] Hu FP, Guo Y, Zhu DM, et al. Resistance trends among clinical isolates in China reported from CHINET surveillance of bacterial resistance, 2005-2014[J]. Clin Microbiol Infect, 2016,22 Suppl 1:S9-14.
[8] 胡付品,郭燕,朱德妹,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251.
[9] 方全凤.ICU鲍曼不动杆菌感染原因分析和护理对策[J].基层医学论坛,2014,18(3):300-302.
[10] 张辉,张小江,徐英春,等.2005—2014年CHINET不动杆菌属细菌耐药性监测[J].中国感染与化疗杂志,2016,16(4):429-436.
[11] 汪红,胡龙华,宁长秀,等.耐碳青霉烯类抗生素鲍曼不动杆菌耐药机制的研究[J].中国临床药理学与治疗学,2014,19(10):1093-1098.
[12] Vardakas KZ, Tansarli GS, Rafailidis PI. Carbapenems versus alternative antibiotics for the treatment of bacteraemia due to Enterobacteriaceae producing extended-spectrum β-lactamases: a systematic review and meta-analysis[J]. J Antimicrob Chemother, 2012,67:2793-2803.
[13] 王云凤,姜雪.重症医学科病人标本分离鲍曼不动杆菌耐药谱变迁[J].中国消毒学杂志,2014,31(12):1307-1309.
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